Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

Stephanie Cummins

Medicaid and Private Insurance Claim(s) Verifier
Katy,TX

Summary

Highly skilled Medical Claims Specialist with extensive experience in Medicaid verification, claims processing, and data accuracy. Adept at reviewing, verifying, and processing healthcare claims with strong attention to detail and compliance with HIPAA regulations. Proficient in MS Excel, claims management systems, and data validation techniques to optimize accuracy and efficiency. Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.

Overview

19
years of professional experience

Work History

BCForward - Remote

Medical Claims Specialist
08.2023 - 01.2025

Job overview

  • Processed and verified Medicaid claims, ensuring accuracy in patient eligibility and benefits determination
  • Conducted detailed claims reviews, identifying errors and discrepancies to prevent claim denials and payment delays
  • Applied knowledge of Medicaid regulations and HIPAA compliance to ensure adherence to federal and state healthcare policies
  • Utilized claims management software and Excel to track, analyze, and update claim statuses efficiently
  • Assisted in appeals and resubmission of denied claims, collaborating with providers and payers to resolve issues
  • Managed large volume of medical claims on daily basis.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Reviewed provider coding information to report services and verify correctness.
  • Responded to correspondence from insurance companies.
  • Monitored and updated claims status in claims processing system.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Maintained confidentiality of patient finances, records, and health statuses.

Aloha Restaurant Group, LP
Houston, TX

Payroll and HR Administrator
02.2012 - 12.2021

Job overview

  • Approve time keeping files and upload data files on a bi-weekly basis to ADP for multiple Restaurant’s
  • Preview files of final payrolls for processing
  • Address payroll related concerns that arise during the payroll processing
  • Address employee specific payroll questions
  • Work closely with ADP tax and garnishment teams regarding any new notices and to ensure compliance reporting to various agencies
  • Maintain company and business structure data: job titles, locations, departments, etc

Willrodt & Associates, Attorneys
Houston, TX

Legal Assistant
01.2006 - 12.2011

Job overview

  • Perfected and circulated documentation including, affidavits, pleadings, subpoenas, interrogatories, deposition notices, and briefs, for review by attorneys
  • Scheduled client appointments and consultations
  • Kept case files up to date
  • Supported attorneys in filing appeal briefs before Harris County District and Probate Courts
  • Gathered and analyzed state and county statutes and precedents

Education

Houston Community College
Houston, TX

Associate of Arts

University Overview

Skills

  • Medicaid Claims Processing, Adjustments and Regulations
  • MS Excel and Microsoft Office
  • HIPAA Compliance
  • Attention to Detail
  • Time Management and Communication Skills
  • Medical Terminology Familiarity
  • Reliability
  • Patient Contact
  • Attention to Detail

Timeline

Medical Claims Specialist
BCForward - Remote
08.2023 - 01.2025
Payroll and HR Administrator
Aloha Restaurant Group, LP
02.2012 - 12.2021
Legal Assistant
Willrodt & Associates, Attorneys
01.2006 - 12.2011
Houston Community College
Associate of Arts
Stephanie CumminsMedicaid and Private Insurance Claim(s) Verifier