Summer Pate
Irving,TX
Summary
Approachable Medical Claims Processor proudly offering over 5 years' experience in handling multiple administrative responsibilities in fast-paced office environments. Hardworking professional interacting with providers to discuss claim status or denials. Attentive to details and highly collaborative.
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
10
10
years of professional experience
Work History
Medical Claims Processor III
Cognizant Technologies Solutions
Plano, TX
01.2021 - 06.2024
- Accurately processed large volume of medical claims every shift. (100)
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
- Reviewed claims for accuracy before submitting for billing.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
Revenue Cycle Specialist II
Gaffey Healthcare
Plano, TX
02.2018 - 12.2020
- Completes 60 account reconciliations daily.
- Maintained confidentiality on all patient record data.
- Executed medical billing including submitting claims to insurance companies and researching and resolving denials and explanation of benefit rejections within billing cycle timeframe.
- Administered standard contract benefits to process pending claims for dental benefits.
- Documented file notes clearly and concisely in Dentrix.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Delivered exceptional customer service to all clients by effectively communicating information and actively listening to concerns.
- Identified and corrected payment problems involving patients or third-party payers.
- Contacted insurance providers to check patient coverage.
- Produced accounting reports and provided targeted recommendations for improving revenue standing.
- Reached out to responsible companies and individuals to collect on outstanding debts.
- Maintained up-to-date contact information for each case under review.
Revenue Cycle Specialist I
Conifer Health Solutions
Frisco, TX
03.2017 - 02.2018
- Contacted insurance providers to check patient coverage.
- Maintained up-to-date contact information for each case under review
- Utilized ACE software for collecting of hospital claims.
- Followed up on Appeals and Payments
- Worked with various, payer portals for commercial payers.
- Performed full research to check claims and possible solutions to individual issues.
- Gathered and reviewed rejected claim information in order to develop successful resolutions.
- Researched 50 claims in order to evaluate correct coverage and liability.
Insurance Verification Specialist I
Texas Regional Asthma and Allergy
Southlake, TX
10.2016 - 02.2017
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Verified that patients had the proper insurance coverage prior to any procedures or appointment scheduling.
- Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information.
- Handled billing related activities focused on medical specialties.
- Check in and out patients
- Scheduled appointments through Care Cloud.
Patient Care Advocate I
Derm One Dermatology
Irving , TX
06.2015 - 08.2016
- Assist Patients with Dermatology appts of a group of 40 providers, for several of their clinical locations in NJ, PA, TX, NC.
- Learn to operate new office technologies as they developed and implemented.
- Utilized Athena Medical Software
Payroll Clerk
Integracare Home Health
Bedford , TX
02.2014 - 06.2015
- Administered payroll for over 2,000 patient care assistants.
- Protected payroll operations and maintained employee confidence by keeping information private.
- Increased employee satisfaction by 100% by accurately handling payroll help desk and answering questions regarding correct and accurate payroll time entry.
- Managed weekly payroll duties and submitted data to Santrax.
Education
Long Term Care - Healthcare
Indian College Technology
Muskogee, OK09.2013
Associate of Arts - General Studies
Northeastern State University
Tahlequah, OK05.2012
Medical Billing And Coding - Healthcare
Anthem College
Irving, TX05.2005
Skills
- Exhibits a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines
- Review and work on claim edits
- Works payor rejected claims for resubmission
- Exhibits and understanding of electronic claims editing and submission capabilities
- Works collector queue daily utilizing appropriate collection system and report
- Identify and communicate trends impacting account resolution
Timeline
Medical Claims Processor III
Cognizant Technologies Solutions
01.2021 - 06.2024
Revenue Cycle Specialist II
Gaffey Healthcare
02.2018 - 12.2020
Revenue Cycle Specialist I
Conifer Health Solutions
03.2017 - 02.2018
Insurance Verification Specialist I
Texas Regional Asthma and Allergy
10.2016 - 02.2017
Patient Care Advocate I
Derm One Dermatology
06.2015 - 08.2016
Payroll Clerk
Integracare Home Health
02.2014 - 06.2015
Long Term Care - Healthcare
Indian College Technology
Associate of Arts - General Studies
Northeastern State University
Medical Billing And Coding - Healthcare
Anthem College