Silas Black
Murfreesboro,TN
Summary
Proven Medical Claims Analyst with a track record of enhancing productivity and customer satisfaction at Healthscope/UMR. Excelled in claims processing proficiency and HIPAA compliance, significantly reducing fraudulent claims. Skilled in mentoring with a keen focus on continuous improvement and regulatory adherence. Demonstrates exceptional attention to detail and a strong foundation in medical terminology.
Overview
10
10
years of professional experience
Work History
Medical Claims Analyst
Healthscope/UMR
12.2014 - Current
- Achieved successful resolutions on disputed claims through effective collaboration between internal departments such as legal counsel and clinical experts.
- Managed high-volume caseloads for optimal productivity while maintaining strict attention to detail.
- Conducted comprehensive audits to identify inconsistencies and irregularities in medical claims data.
- Assisted in the development of standardized processes for claim adjudication across multiple insurance products.
- Maintained regulatory compliance by staying current with industry guidelines, state laws, and federal regulations.
- Demonstrated a commitment to continuous improvement by actively seeking out opportunities for process optimization within the Medical Claims Analyst role.
- Improved customer satisfaction by resolving complex medical claims in a timely and professional manner.
- Reduced fraudulent claims by conducting thorough investigations and collaborating with the fraud detection team.
- Ensured accurate payments by meticulously reviewing medical records, invoices, and supporting documentation.
- Verified patient insurance coverage and benefits for medical claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Managed large volume of medical claims on daily basis.
- Responded to correspondence from insurance companies.
- Processed insurance payments and maintained accurate documentation of payments.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Calculated adjustments, premiums and refunds.
- Maintained confidentiality of patient finances, records, and health statuses.
- Mentored junior analysts within the team to promote professional growth opportunities amongst peers.
Education
High School Diploma -
Antioch High School
Antioch, TN05-1994
Skills
- Claims processing proficiency
- HIPAA compliance
- Training and mentoring
- Medical terminology
Timeline
Medical Claims Analyst
Healthscope/UMR
12.2014 - Current
High School Diploma -
Antioch High School
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