Stephanie Swiger
Wheeling,WV
Summary
At The Health Plan, I leveraged my expertise in medical coding to enhance claims processing accuracy by meticulously verifying documentation and identifying discrepancies. My efforts significantly reduced processing errors and time, demonstrating strong attention to detail and problem-solving abilities.
Experienced with medical claims analysis, ensuring accuracy and compliance in claim processing. Knowledge of healthcare regulations and coding practices to streamline processes and enhance claim accuracy.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Medicare Medical Claims Analyst
The Health Plan
09.2018 - Current
- ,Processed medical claims to ensure accurate and timely payments.
- Improved accuracy of claims with thorough verification and documentation.
- Analyzed claims data to identify discrepancies, enhancing overall integrity.
- Ensured compliance with regulations by meticulously reviewing each claim.
- Assisted team in reducing processing time for faster claim outcomes.
- Reduced errors in claims processing, maintaining high standards of accuracy.
- Managed complex claims cases, resolving issues to facilitate smooth operations.
- Identified trends in claims data to suggest process improvements.
- Verified patient information to maintain accurate claims records.
- Maintained regulatory compliance by staying current with industry guidelines, state laws, and federal regulations.
- Ensured accurate payments by meticulously reviewing medical records, invoices, and supporting documentation.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- 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, surpassing the required 144 claims per day.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Education
High School Diploma -
West Virginia Northern Community College
Wheeling05.1999
Skills
- Claims processing
- Medical terminology
- Attention to detail
- Insurance claims
- Problem solving
- Communication skills
- Time management
- Medical coding
- Document review
- Claim adjudication
- Team collaboration
- Decision making
- Medical billing
- Critical thinking
- Claims processing proficiency
- HIPAA compliance
- Medical coding expertise
- Insurance claims processing
- ICD codes
- Electronic claims processing
- Teamwork and collaboration
- Multitasking Abilities
- Decision-making
- Reliability
Certification
Certified Billing and Coding Specialist (CBCS)
Certified Medical Administrative Assistant (CMAA)
Certified Medical Coder (CMC)
Timeline
Medicare Medical Claims Analyst
The Health Plan
09.2018 - Current
High School Diploma -
West Virginia Northern Community College
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