Facets
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.
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
Facets
QNXT
Epic Tapestry, Mychart, and Cadence
Diamond
Xcelys
3MEncoder