Susie Washington
Lewisville,TX
Summary
Dedicated and professional healthcare claims professional with 2 years of experience seeking a challenging Claims Processor role. Strong proficiency in ICD-10 coding, reimbursement procedures, and improving claims approval processes. Adept at utilizing Zendesk for exceptional customer support. Proven track record in reducing claim denial rates and enhancing processing efficiency in medical claims environments. Committed to delivering accurate and timely results.
Overview
3
3
years of professional experience
Work History
Medical Claims Examiner
First Source
12.2023 - Current
- Evaluate medical claim coverage and eligibility, ensuring compliance with coding standards and regulatory mandates
- Reduce claim denial rates by analyzing and rectifying denied claims to improve approval processes
- Verify medical records, invoices, and supporting documents for accuracy, utilizing ICD-10 and ICD-9 coding knowledge to streamline claim processing.
- Demonstrated exceptional understanding of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) to interpret EOBs for payment breakdown and posting accurately.
- Maintained clear, concise, and accurate documentation of all account interactions and resolutions in accordance with HIPAA, FDCPA, and other regulatory requirements.
Medical Claims Processor
The Cigna Group
01.2023 - 09.2023
- Ensured 95% accuracy in insurance verification, leading to a reduction in billing errors and lower claim denial rates
- Implemented procedural improvements that reduced medical claims processing time by 20%
- Improved claims resolution efficiency by prioritizing tasks, achieving a 25% faster turnaround time.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified and analyzed patient insurance coverage and benefits for over 400 medical claims daily, ensuring accurate processing and minimizing claim denials.
- Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
ASIC Chat Support Specialist
Allstate Insurance Co
06.2021 - 08.2022
- Achieved high customer and agent satisfaction through dedicated service, leading to a well-earned promotion
- Utilized effective questioning strategies in support interactions to identify and match client requirements with appropriate insurance products
- Performed in-depth policy and record examinations, ensuring precise coverage determinations and playing a key role in attaining a 97% customer satisfaction rate.
- Implemented feedback from management to continually improve performance metrics within the chat support team.
- Successfully maintained a positive, professional demeanor even during challenging customer interactions, serving as a role model for other chat support specialists and contributing to a positive team culture that prioritized excellent service delivery above all else.
Education
Bachelor of Science - Health Information Management
Western Governors University
Salt Lake City, UT03.2025
A.S. - Liberal Arts and Criminal Justice
Faulkner State Community College
Bay Minette, AL08.2008
Skills
- Well-Versed in ICD-10-CM, CPT, and HCPCS Level II Coding Systems
- Proficient in Applying Official Coding Guidelines and Conventions
- Federal Regulations
- Knowledge of Medical Billing Procedures
- Familiarity With the Health Insurance Portability and Accountability Act (HIPAA)
- Understanding of Healthcare Regulations and Compliance
- Payment Processing
- Proficiency With Claims Management Software
Timeline
Medical Claims Examiner
First Source
12.2023 - Current
Medical Claims Processor
The Cigna Group
01.2023 - 09.2023
ASIC Chat Support Specialist
Allstate Insurance Co
06.2021 - 08.2022
Bachelor of Science - Health Information Management
Western Governors University
A.S. - Liberal Arts and Criminal Justice
Faulkner State Community College
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