Summary
Overview
Work History
Education
Skills
Websites
Timeline
Generic

Tracey Furman

Port Richey,FL

Summary

Advanced Claims Analyst with 7 years of experience overseeing medical claims. Able to manage assigned claims following company guidelines and industry best practices with a minimal amount of supervision. Comfortable performing other tasks and duties within claims departments as dictated by business needs. Demonstrates ability to complete tasks accurately despite interruptions and varying demands. Initiative-taking employee with desire to take on new challenges with a strong worth ethic, adaptability, and people skills. Adept at working effectively and efficiently unsupervised and can quickly master new skills.

Overview

7
7
years of professional experience

Work History

ADVANCED CLAIMS ANALYST

Centene Corporation
10.2020 - Current
  • Work from home full time on multiple screens and applications
  • Effectively prioritize and organize each workday
  • Maintains and exceeds department claims per hour and accuracy standards
  • Experience with Processing PPO/HMO/POS Commercial and Medicaid 1500/UB04 first time claims, Coordination of Benefits, adjustments/reclass/corrected claims
  • Completes accurate analysis to ensure payments and/or denials are made in accordance with company practices and procedures
  • Apply policy and provider contract provisions to determine application of allowed amounts, manually price claims based on specific rates utilizing Burgess, Fair Health, Multi Plan, DST Health Solutions, Data iSight, and Webstrat
  • Route claims to appropriate department if required, such as, high dollar, special pricing, refunds, and/or adjustments on resubmitted claims
  • Record data and data entry inputs with functions in Excel
  • Trained in Golden 7 Benthic Software queries, perform data editing, import, and export for Excel spreadsheets
  • Makes suggestions to improve overall processes and procedures of claims process
  • Supports claims operations teams by aiding other departments when business demands.

VA CLAIMS RESOLUTIONS

Insight Global/Sutter Shared Services
10.2019 - 04.2020
  • Fully trained on utilization of EPIC software
  • Investigated, resolved, and pursued claims recoveries on 40 - 100 veteran's accounts daily
  • Initiated phone calls to TriWest, Wisconsin Physician Services, Veteran's Administration, VISN 20, VA PC3, VA Community Care Program, Choice and VISN 21 to resolve claim denials, obtained and verified authorizations
  • Recovered incorrectly processed claims through claim's adjustment process
  • Responded accurately, courteously, and quickly to phone and written correspondence related to contract, provider, client, and insureds' inquiries or concerns with appropriate follow up, as necessary
  • Contacted veterans for coordination of benefits when necessary
  • Routed claims to appropriate departments for resolution if necessary
  • Researched, drafted, and submitted written appeals pertaining to denied claims payments.
  • Collected information about rejected claims and developed effective solutions

MEDICAL CLAIMS EXAMINER

Kelly Services/HealthNet Federal Services
11.2017 - 10.2019
  • Verified and analyzed data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
  • Examined, processed, calculated, and refunded duplicate claim payments, overpayments, and wrong provider/patient payments
  • Requested additional information from providers if needed to process refunds
  • Entered claim payments to correct providers
  • Redirected refunds to correct insurance carrier
  • Utilized databases to retrieve provider check and electronic transfer information
  • Verified authorizations for medical services
  • Researched claims payments and pursued recoveries through contact with various parties and/or claim recoupment, as needed
  • Managed all claims that required recovery for overpaid or incorrectly paid claims, coordination of benefits with other insurance companies, claims paid after termination, claims paid to wrong providers, duplicate payments, subrogation refunds and all other claims scenarios
  • Managed complex caseloads of claims identified for potential offset ensuring high quality and appropriate claim payment activity.

ACCOUNT MANAGER/BALANCE FORWARD

McCormick Enterprises
10.2016 - 07.2017
  • Worked claims and claim denials to ensure maximum reimbursement for services provided
  • Collected delinquent accounts by establishing payment arrangements with patients; monitoring payments; and following up with patients when payment lapses occur
  • Performed and prepared audits and appeals, as necessary
  • Researched and retrieved authorizations and medical charts for claims denials and resubmission
  • Utilized collection agencies to collect patient accounts
  • Managed third party billing for ten physical therapy and chiropractic clinics
  • Insurance companies worked with daily: MedRisk, Sedgwick, Blue Cross, Blue Shield, Health Net, TriWest and Medicare.

Education

Associate of Applied Science - Medical Office Management

Allied American University
Laguna Hills, CA
05.2016

Skills

  • Outstanding organizational, time-management, problem solving and adaptability skills
  • Electronic Health Information Management
  • ICD-10/ICD-9
  • EPIC, Quantum Choice, AMYSIS Managed Care System
  • Golden 7 Benthic Software
  • Burgess, Fair Health, Multi Plan, Data Isight, DST Health Solutions, and Webstrat
  • MS Excel, Word, Outlook
  • Claims Review
  • Payment Processing
  • Data Entry
  • Research

Timeline

ADVANCED CLAIMS ANALYST

Centene Corporation
10.2020 - Current

VA CLAIMS RESOLUTIONS

Insight Global/Sutter Shared Services
10.2019 - 04.2020

MEDICAL CLAIMS EXAMINER

Kelly Services/HealthNet Federal Services
11.2017 - 10.2019

ACCOUNT MANAGER/BALANCE FORWARD

McCormick Enterprises
10.2016 - 07.2017

Associate of Applied Science - Medical Office Management

Allied American University

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