TERANEY MOORE
Spring,TX
Summary
Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Hardworking professional applies official coding conventions and rules established by the American Medical Association and the Centers for Medicare and Medicaid Services. A Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.
Overview
15
15
years of professional experience
Work History
Claims Examiner
Humana
01.2024 - Current
- Handled sensitive information with discretion, ensuring the confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Resourcefully used various coding books, procedure manuals, and online encoders.
- Applied official coding conventions and rules from the American Medical Association and the Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Enhanced team efficiency with regular training sessions on new coding updates and best practices.
- Promoted teamwork within the department through effective communication and collaboration on complex cases.
- Reduced claim denials by maintaining thorough knowledge of payer-specific requirements and guidelines.
Claims Examiner (Remote)
Sedgwick Claims
11.2020 - 12.2023
- Processes general disability claims by gathering information to determine liability exposure; assigns reserve values to claims, makes claims payments as necessary, and settles claims up to designated authority level
- Develops and coordinates general disability claims' action plans to resolution, return-to-work efforts, and approves claim payments
- Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract
- Administers subrogation of claims and negotiates settlements
- Communicates claim action with claimant and client
- Ensures claim files are properly documented and claims coding is correct
- May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
- Maintains professional client relationships
- Processed Workman compensation claims
- Paid and processed claims within designated authority level.
- Handled and processed variety of claims, including LTD and WC.
- Entered claim transactions, payments, reserves and other documentation.
- Reviewed claims to ensure accuracy, resulting in multiple claim reductions.
- Double-checked and reviewed documentation for denied and accepted insurance claims.
- Investigated questionable claims to determine payment authorization.
- Evaluated evidence with ultimate goal of creating positive outcomes for client's claims.
- Obtained necessary information to complete proper evaluation of injury claims.
- Performed data entry into the computer system to record information regarding claim status.
- Developed a detailed understanding of the company's policies and procedures related to claim processing and payment determination.
- Managed workloads efficiently by prioritizing tasks based on urgency or importance.
- Participated in quality assurance activities such as peer reviews and audits.
- Investigated discrepancies in claims and resolved issues with customers via telephone or written correspondence.
- Tracked progress of pending cases through manual follow-up or automated systems.
Martiz Customer Service Rep Dedicated (Remote)
BPO AMERICAN
11.2018 - 11.2020
- Process all reservation requests, changes, and cancellations received by phone, chat, and email
- Inbound calls/Outbound calls
- Identify guest reservation needs and determine appropriate room type
- Verify availability of room type and rate
- Explain guarantee, special rate, and cancellation policies to callers
- Input and access data in reservation system
- Answer questions about property facilities/services and room accommodations
- Answering service customer service representative.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
- Assisted customers with making payments or establishing payment plans to bring accounts current.
- Fielded customer complaints and queries, fast-tracking for problem resolution.
- Upheld quality control policies and procedures to increase customer satisfaction.
- Escalated customer concerns, issues and requirements to supervisors for immediate rectification.
- Answered inbound calls, chats and emails to facilitate customer service.
- Set up and activated customer accounts.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Gathered customer feedback through surveys and used the data to improve customer service.
- Provided excellent customer service to resolve customer complaints in a timely manner.
Life Insurance Agent
PHP Agency Inc.
08.2018 - 10.2020
- Communicated with clients to understand needs and identify best policies for each case.
- Sold life insurance policies via telephone and assisted other agents with underwriting.
- Upsold products to policyholders and potential new clients.
- Pursued continued professional development through insurance workshops, course and webinars.
- Exceeded company sales goals for new policies.
- Calculated premiums and established payment methods.
- Provided leadership and training for new agents regarding industry best practices and company policies.
- Educated clients on various types of life insurance policies available in the market.
- Assisted customers in selecting the right life insurance coverage for their needs.
- Reviewed existing contracts to make sure they are compliant with state regulations.
- Attended educational seminars and conferences to stay up-to-date on industry trends.
- Evaluated current financial situation of clients before recommending any policy changes.
- Maintained records of client information, including policies and payment history.
Insurance Sales Agent
Evergreen Insurance Agency
09.2016 - 06.2018
- Account management Data Entry Telemarketing
- Reached out to business owners to introduce our services.
- Ensured that all required documents are properly filled out before submission.
- Researched and analyzed beneficial insurance and investment options and made recommendations to clients.
- Responded to inquiries and explained product features and service advantages to potential customers.
- Provided guidance about different types of insurance products available.
- Performed administrative tasks such as updating databases, filing paperwork.
- Advised clients on coverage amounts needed based on individual circumstances.
Service Agent (Temp)
DHL Express ServicePoint
12.2015 - 08.2016
- Arranged shipments for clients
- Compared shipment contents with paperwork to support inventory accuracy and records management.
- Reviewed accuracy of invoices and bills of lading.
- Communicated with carrier representatives to follow specific procedures and make special delivery arrangements.
- Created labels for outgoing packages according to customer requirements.
- Haliburton Involvement with presenting bids for potential clients Sent pre-alerts via email to customers of our clients Data entry and account management
- Received training on country tariffs and laws Email FedEx labels to all clients
- Checked customer orders, labeling and documentation prior to shipment to avoid delays.
Collection and Insurance Specialist
Getix Health Healthcare
02.2014 - 09.2015
- Medical Insurance claim and processing
- Medical debt collections
- Direct contact with consumers to make payment arrangements
- Conducted follow up on Insurance claims
- Submitted reports to expedite claim payments
- Conducted resolutions to resolve accounts
- Managed denials, late payments, extensions and other special circumstances by following up with relevant parties.
- Resolved routine and complex issues by performing detailed research.
- Collaborated with carriers to resolve discrepancies in insurance payments.
- Followed up on unpaid claims within established timelines according to regulations set forth by payers and insurers.
- Resolved disputes related to insurance collections including appeals, adjustments, refunds and credits owed to customers.
- Actively participated in team meetings to discuss progress towards goals and objectives.
- Adhered strictly to HIPAA compliance regulations when handling confidential patient information.
- Performed outbound calls to collect past due balances from insurance companies or other third parties.
- Reviewed Explanation of Benefits documents for accuracy prior to submitting them for payment processing.
Insurance Specialist
American Health First
07.2013 - 02.2014
- Medical Insurance billing and claim processing
- Direct contact with insurance companies
- Verified insurance and status
- Completed add on insurance reports
- Customer relations
- Submitted reports for UB400 billing
- Follow-up on insurance claims
- Account management
- Process appeals
- Account reconciliation
Medical Debt Collector
FMA Alliance
01.2011 - 07.2013
- Verified and obtained customer information from creditors and other sources
- Assured ongoing contact by updating and maintaining customer profile according to company guidelines
- Calculated payments arrangements and settlements on accounts according to company guidelines
- Documents consumer files after each attempt
- Assist in training as needed
- Fulfill other duties as assigned
- Oversaw daily collections and accounts receivable activities, developing robust strategies to maximize collections and reduce aged accounts.
- Protected medical office operations and integrity by keeping patient information confidential.
- Updated patient profiles in the database system after each completed transaction.
- Assisted patients in understanding their billings statements, insurance coverage, and payment options available.
- Maintained detailed records of all correspondence with patients concerning their debts.
- Responsible for contacting patients with outstanding medical debt and negotiating payment plans.
- Conducted outbound calls to customers regarding past due balances, payment arrangements, and other account inquiries.
- Researched insurance policies to determine coverage amounts owed by the patient.
- Utilized skip tracing techniques when attempting contact with hard-to-reach debtors.
Education
Associate - Business Management & Marketing
Lonestar College
01-2006
Skills
- Life Insurance
- File and Record Management
- Claims Processing
- Active Listening
- Relationship Building
- Workers' Compensation Claims
- Procedural coding
- Customer Service and Support
- Benefit Explanation
- Payment Processing
- Records Review
- MS Office
- Claims File Management Processes
- Computer Skills
- Data Entry
- Scheduling
- Account Updating
- Product Knowledge
- Data Collection
- Order Processing
- Administrative Support
- Microsoft Outlook
- Customer Relationship Management (CRM)
- Sales Closing
- Customer Relations
- Conflict Mediation
- Delivery Scheduling
- Adaptive Team Player
- Quality Control
- Typing Proficiency
- Office Equipment Proficiency
- Positive and Professional
- Computer Proficiency
- Shipping and Receiving Understanding
- Customer Service
- Typing 60 WPM
- Order Fulfillment
- Spreadsheets
- Call Center Operations
- Credit Card Payment Processing
- Professional Telephone Demeanor
- Documentation
- Proofreading
- Medical Terminology Knowledge
- Research
- Claims processing
- Disability claims process
- HCPCS coding
Timeline
Claims Examiner
Humana
01.2024 - Current
Claims Examiner (Remote)
Sedgwick Claims
11.2020 - 12.2023
Martiz Customer Service Rep Dedicated (Remote)
BPO AMERICAN
11.2018 - 11.2020
Life Insurance Agent
PHP Agency Inc.
08.2018 - 10.2020
Insurance Sales Agent
Evergreen Insurance Agency
09.2016 - 06.2018
Service Agent (Temp)
DHL Express ServicePoint
12.2015 - 08.2016
Collection and Insurance Specialist
Getix Health Healthcare
02.2014 - 09.2015
Insurance Specialist
American Health First
07.2013 - 02.2014
Medical Debt Collector
FMA Alliance
01.2011 - 07.2013
Associate - Business Management & Marketing
Lonestar College
Additional Information
AREAS OF STRENGTH 10 years of successful customer service and support with recognized strengths in account maintenance, problem solving, planning, and implementing proactive procedures. Possess solid computer skills Ability to train, motivate, and supervise employees Develop plans, conduct audits and variance analyses, data entry and filings, and maintain/ update accurate inventories
Similar Profiles
Lindsey WilsonLindsey Wilson
Grievance & Appeals Representative 3 at HumanaGrievance & Appeals Representative 3 at Humana
Monifah CocroftMonifah Cocroft
Healthcare Customer Service Representative at HumanaHealthcare Customer Service Representative at Humana
James BarnettJames Barnett
Data Manager 2 at HumanaData Manager 2 at Humana
Jacqueline AugustinJacqueline Augustin
Lead Medical Assistant 4 at HumanaLead Medical Assistant 4 at Humana
Miaonaye RoseMiaonaye Rose
Valet at LAZ ParkingValet at LAZ Parking