Thomas Miller
Dayton,OH
Summary
At Navia Benefit Solutions, I excelled in processing high-volume medical claims, enhancing efficiency by identifying process improvements and reducing rework costs. My commitment to customer service led to significant achievements in claim resolution and compliance, ensuring high levels of customer satisfaction and adherence to HIPAA regulations.
Overview
7
7
years of professional experience
Work History
Medical Claims Processor
Navia Benefit Solutions
01.2018 - 12.2024
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Identified and resolved discrepancies between patient information and claims data.
- Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
- Ensured compliance with all applicable regulations by maintaining strict adherence to HIPAA guidelines and company protocols when handling sensitive patient information.
- Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
- Contributed to positive team morale through active participation in department meetings, offering constructive feedback, and supporting colleagues when needed.
- Identified opportunities for process improvements within the claims department, leading to increased overall efficiency and reduced costs associated with claim reworkings.
Education
BBA - Human Resources Management
Marshall University
Huntington, WV12-1985
Skills
- Critical Decision-making
- ICD-10-cM coding
- Customer service
- Claim denial resolution
Timeline
Medical Claims Processor
Navia Benefit Solutions
01.2018 - 12.2024
BBA - Human Resources Management
Marshall University
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