Summary
Overview
Work History
Education
Skills
Timeline
Generic

Stephanie Morgan

Henderson,NV

Summary

Detail-oriented Health Insurance Claims Professional with 16+ years of experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of claims process, appeals, member and provider relations.

Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Excellent communication skills with ability to relate well with members, providers, staff and management at all levels. I'm extremely motivated and ready to learn new things where my existing skills can be utilized.

Overview

14
14
years of professional experience

Work History

Claims Auditor

Easy Care MSO
12.2022 - Current
  • Daily claims auditing
  • Preparation and presentation for health plan audits.
  • Organized, planned and documented materials for Professional and hospital claims.
  • Examined claims forms and other records to determine insurance coverage.
  • Negotiated claim settlement agreements to resolve disputes.
  • Finalized files for insurance claim payment release.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Researched issues related to claims processing to identify origins and implement corrective solutions.

Medicare Auditor

Medpoint Management
04.2019 - 02.2022
  • Claim audit and appeals
  • Member grievances
  • Claims training
  • Symkey Processing
  • High dollar claim review
  • DOFR review and health plan verification
  • Provider and Member calls for our resolutions team



Senior Claims Examiner

Alignment Healthcare
01.2016 - 09.2018
  • Review & Process Medicare Hospital & Professional claims
  • Both manually and using Symkey application
  • Verifying DOFR, member EOC and provider’s contract
  • Exceeding production and quality company’s standard
  • Provider and Member calls.

Senior Claims Examiner

Nevada Health Co, op
05.2015 - 01.2016
  • Review & Process all claim types for several LOB
  • Member and Provider Appeals
  • Special projects and High dollar claims including Stop-loss.

Claims Recovery Specialist

HMS Holdings Corp
08.2014 - 04.2015
  • Perform audits of claims processed by the claims department for various claims companies
  • Determine potential coverage and develop collection strategies by reviewing claims processed for several Health Plans
  • Prepare and mail overpayment letters to providers
  • Post recovery/ overpayment checks into claim’s data base for tracking and reporting.

Appeals Analyst

Dell Inc, United Health Care
06.2013 - 08.2014
  • Researched and Processed Claim Appeals & PDR
  • Special Projects

Claims Recovery Specialist

Scan Health Plan
06.2009 - 04.2011
  • Review and audit claims processed for possible overpayments
  • Processed & post all incoming refund checks
  • Update and maintain accurate account of collections activity and incoming payments on claim files
  • Member Services, claims calls questions and disputes.

Education

Certification - Medical Claims And Medical Billing Certification

American Career College
Anaheim, CA
06.2003

Skills

  • Cultural Awareness
  • Microsoft Office
  • Reports and Documentation
  • Audit Programs and Processes
  • Excellent communication skills
  • Coordination of Benefits
  • Microsoft Word, Excel, PowerPoint
  • Claims Processing & Appeals
  • Problem-Solving Ability
  • Strong Analytical & Organizational skills
  • Recovery & Overpayments
  • Member and Provider Grievances

Timeline

Claims Auditor

Easy Care MSO
12.2022 - Current

Medicare Auditor

Medpoint Management
04.2019 - 02.2022

Senior Claims Examiner

Alignment Healthcare
01.2016 - 09.2018

Senior Claims Examiner

Nevada Health Co, op
05.2015 - 01.2016

Claims Recovery Specialist

HMS Holdings Corp
08.2014 - 04.2015

Appeals Analyst

Dell Inc, United Health Care
06.2013 - 08.2014

Claims Recovery Specialist

Scan Health Plan
06.2009 - 04.2011

Certification - Medical Claims And Medical Billing Certification

American Career College
Stephanie Morgan