Summary
Overview
Work History
Education
Skills
Affiliations
Work Preference
Software
Work Availability
Timeline
TRACY J KING-CAMERON

TRACY J KING-CAMERON

Health Information Technology and Claims Specialist
Houston,TX

Summary

Highly trained professional with a background in health insurance sector. A motivated, personable business professional with 10+ years of industry experience. I have a history of producing accurate, timely claims payments that meet stringent medical insurance payor guidelines. As a Health Information Technology student, I am actively pursuing the RHIT Certification through AHIMA. I plan to take the certification in December 2024 to demonstrate my commitment to continuous professional development. I have a talent for quickly mastering technology, as demonstrated by my ability to thrive in deadline-driven environments. For instance, I successfully learned and utilized EHR systems like EPIC. I have a strong working knowledge with clams processing system such as Facets, Qnxt, Epic Tapestry and EZCap to process medical claims and provider appeals. My experience in handling sensitive, confidential records, coupled with my knowledge of HIPAA compliance and protection of private health information, instills a sense of security in my professional interactions. in insurance claims payment, insurance benefits and creating appropriate patient documentation.

Overview

20
20
years of professional experience

Work History

Senior Claims Benefit Specialist

Texas Children's Health Plan
05.2023 - 05.2024
  • While maintaining high accuracy, processed medical claims, corrected payment errors, analyzed denied/downgraded MS-DRG and APR-DRG claims, handled provider appeals, and educated providers on billing issues and denials through Epic Tapestry and EPIC CRM system.
  • Maintained knowledge of Medicaid benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Paid or denied medical claims based upon established Texas Medicaid claims processing criteria.
  • Managed large volume of medical claims on daily basis.

SENIOR CLAIMS SPECIALIST

NTT Data - Remote
05.2021 - 07.2023
  • Analyzed medical claims, processed adjustments and refunds using various software tools like Facets, Macess, and Java.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Coordinated with contracting department to resolve payer issues.

Claims examiner

Memorial Clinical Associates - Houston, TX
09.2018 - 09.2020
  • Managed complex inpatient, outpatient, infusion therapy, adjustments, and cob for Medicare Advantage plans using Facets.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Reviewed provider coding information to report services and verify correctness.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Assessed medical claims for compliance with regulations and corrected discrepancies.

Benefits Specialist

Aetna Healthcare/Coventry – Houston, TX
10.2015 - 09.2018
  • Processed medical and dental insurance claims
  • Using auto adjudication and manual processing
  • Medicare Part C Advantage plan.
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Coordinated with contracting department to resolve payer issues.
  • Calculated adjustments,and refunds.

Claims examiner

DB Healthcare BPO - Houston, TX
05.2015 - 10.2015
  • Handled medical claims and adjustments for the Medicare Advantage plan.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Managed large volume of medical claims on daily basis.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Maintained claims data in Facetssystems.

REMOTE SENIOR CLAIMS SPECIALISTS

Dell BPO - Plano, TX
06.2012 - 06.2014
  • Processed medical claims, adjustments, and retractions to correct payment errors previously processed by claims processors or systems
  • Provide customer services to providers for NY State Medicaid
  • Process claims for PPOs and HMOs
  • Processing systems used were Qnxt, Facets, Diamonds, and Xcelys.

Education

AAS-HEALTH INFORMATION Technology -

DeVry University
Relevant Coursework: Health Information Management, Medical Terminology, ICD-10-PCS, ICD-10-CM, CPT Coding, Data Analytics, Applied Health Statistics, Anatomy and Physiology, Pathophysiology

Skills

CMS, Medicare Parts A, B and Medicare Advantage products, Medicaid and Medicare Claims, Claims Auditing, Appeals and Grievance (10 years) Third Party Administrator claim processing, Voluntary-Supplemental Benefits claim processing—working knowledge of Epic and Tapestry, Facets, Diamond, Xcelys, Maces, Qnxt, MyChart, EHR, and Quantitative analyses, LTSS services DRG/FFS, methodologies

Affiliations

  • AHIMA

Work Preference

Work Type

Full Time

Work Location

RemoteHybrid

Software

Facets

QNXT

Epic Tapestry, Mychart, and Cadence

Diamond

Xcelys

3MEncoder

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline

Senior Claims Benefit Specialist - Texas Children's Health Plan
05.2023 - 05.2024
SENIOR CLAIMS SPECIALIST - NTT Data - Remote
05.2021 - 07.2023
Claims examiner - Memorial Clinical Associates - Houston, TX
09.2018 - 09.2020
Benefits Specialist - Aetna Healthcare/Coventry – Houston, TX
10.2015 - 09.2018
Claims examiner - DB Healthcare BPO - Houston, TX
05.2015 - 10.2015
REMOTE SENIOR CLAIMS SPECIALISTS - Dell BPO - Plano, TX
06.2012 - 06.2014
DeVry University - AAS-HEALTH INFORMATION Technology,
TRACY J KING-CAMERONHealth Information Technology and Claims Specialist