Surrea Hadley
Pinellas Park,FL
Summary
Experienced in medical claims processing with focus on accuracy and efficiency. Background includes thorough review, validation, adjudication and processing of insurance claims within healthcare sector. Known for strong understanding of ICD-10 codes, HCPCS codes, as well as Medicare and Medicaid regulations. Demonstrated ability to reduce backlogs while maintaining high standards of quality control have driven operational success in previous roles.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Auto Workers Compensation Rep
Baycare Health Systems Inc
Clearwater, FL
05.2024 - Current
- Investigated liability claims and determined coverage based on policy language and applicable law.
- Collects monies owed to the hospital from Auto and Workers Compensation insurance carriers or Employers for inpatient, emergency, and outpatient services.
- Communicates with patients, families, and insurance companies to obtain all necessary information and verify coverage, coordinates benefits amongst various agencies and hospital departments.
- Follows up with insurance companies and attorneys, documents insurance coverages, and performs other duties as assigned.
- Assists customers and insurance companies via call center while maintaining required productivity, quality and customer service levels.
Medical Claims Processor
BayCare Health Systems
Clearwater, FL
12.2016 - 01.2024
- Verified accuracy of provider data entered into the system including tax ID numbers, NPI numbers, address changes .
- Processed a high volume of claims on a daily basis using established time frames.
- Analyzed physician's reports, hospital records, laboratory results, operative reports, diagnostic tests. to assess medical necessity of services rendered.
- Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
- Identified potential fraud cases based on analysis of submitted claims data and escalated accordingly.
- Attended meetings and seminars related to healthcare industry updates.
Medical Claims Specialist
Bayfront Health
St. Petersburg, FL
03.2013 - 12.2016
- Submitted and tracked medical claims to insurance companies via electronic or paper methods.
- Audited provider bills for accuracy before submission to insurance companies.
- Processed appeals on rejected or partially paid claims, including filing additional paperwork as needed.
- Adhered to HIPAA regulations while managing confidential patient information.
- Reviewed denials, rejections, and underpayments from insurance carriers.
- Address and respond to customer concerns in pleasant manner while managing 300+ calls per month.
Care Coordinator
Community Health Centers of Pinellas
St. Petersburg, FL
06.2010 - 01.2013
- Addressed and resolved customer complaints empathetically and professionally
- Patient check in/out
- Scheduled appointments
- Verified Insurance
- Processed applications
- Input information in database
- Scheduled appointments via phone.
Education
HS Diploma -
Gibbs High
Associate of Science -
Hillsborough Community College
Tampa, FLSkills
- ICD-10 and CPT/ HCPC Codes
- HIPAA
- Medical Terminology
- Analytical and Problem-Solving
- Conflict Resolution
- MS Windows proficient/Excel proficient
- Billing and Coding
- Organizational Skills
- Strong Customer Service Skills
- Insurance claims processing
- Provider Relations
- Meticulous recordkeeping
- Strong computer proficiency in the MS Office Suite (Word, Excel, Outlook & PowerPoint)
Certification
Certified Claims Adjuster, 07/2024
System knowledge
- Cerner
- Centricity
- Citrix
- Outlook
- Trace
- IDX
- Cisco
- Pulse
- EDM
- EPR
Timeline
Auto Workers Compensation Rep
Baycare Health Systems Inc
05.2024 - Current
Medical Claims Processor
BayCare Health Systems
12.2016 - 01.2024
Medical Claims Specialist
Bayfront Health
03.2013 - 12.2016
Care Coordinator
Community Health Centers of Pinellas
06.2010 - 01.2013
HS Diploma -
Gibbs High
Associate of Science -
Hillsborough Community College
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