Winifred Oliver
San Antonio,TX
Summary
Knowledgeable Claims Processor capable of reviewing and identifying discrepancies, and independently completing tasks at hand to reach team goals. Highly-motivated employee with desire to take on new challenges in high fast-paced environments. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills with insurance verification, patient documentation and office tasks.
Overview
8
8
years of professional experience
Work History
Medical Claims Processor Remote
BC Forward (Contract Agency)
San Antonio , TX
07.2022 - 09.2023
- Pay, deny, and adjudicated medical/dental, paper and electric claims in accordance with state and federal claim processing guidelines reaching 95% client goals.
- Analyzed physician's reports, hospital records, laboratory results, operative reports, diagnostic tests. to assess medical necessity of services rendered.
- Accessed policyholders profiles to coordinate benefits for Medicare/Medicaid to incorporate cost-containment tools.
- Deciphered UB-04/CMS-1500 claims needing rejections and escalated to higher authority for review or returned to provider for required details to resubmit if applicable.
- Maintained HIPPA and privacy data laws to protect confidentiality of customer information.
- Reviewed medical claims for accuracy and completeness, verifying patient eligibility and coding.
- Processed a high volume of claims on a daily basis using established time frames utilized EHR, Microsoft Office.
Records Management Specialist II, Remote
Remedy Intelligent Staffing (Temp Agency)
San Antonio , TX
04.2021 - 04.2022
- Analyzed order requests using data entry techniques in Electronic Health Records (EHR), serviced 100K veteran medical and/or dental records.
- Maintained files and retrieved information from manual filing systems. Assisted with completion of 235K disability claim exams.
- Utilized phone queue, Microsoft Outlook, and teleconference communications.
- Retrieved and reviewed 50-65 medical exams daily for missing or incomplete documentation required from physicians.
- Discussed management of care stats weekly with regional and clinical managers delivering care to 45 states.
- Relayed and identified discrepancies in processing claims to close the gap on time sensitive orders.
- Managed the migration of paper documents into digital databases.
- Collaborated with stakeholders from multiple departments in order to improve overall efficiency in managing organizational records.
Executive Admin Assistant
DFAS
Lackland Air Force Base, TX , TX
07.2018 - 12.2020
- Multi-tasked, utilized Microsoft Office, transcribed vital material into multiple data sheets across dual screens for Department of Defense services.
- Sorted documents from DoD headquarters to appropriate channels, performed quality checks on automated reports before suspense dates.
- Answered incoming telephone calls from internal and external customers promptly and professionally; transferred calls appropriately; responded to inquiries in a timely manner.
- Prepared agendas for meetings; took minutes during meetings; distributed meeting notes to appropriate personnel.
- Disseminated timely delivery of frontline health taskers from 15 clinical departments. Decreased time missed for onboarding for new hires by 10%.
- Identified use of standardized forms and procedures, centralizing one local station for newcomer’s first stop.
- Developed filing systems to maintain confidential records of personnel information and business activities in accordance with company policies.
Clinical Supervisor, Physical Therapy
DFAS
Lackland Air Force Base , TX
07.2015 - 07.2018
- Managed the physical and occupational therapy departments servicing 240K patients annually.
- Triaged, reviewed 60 medical referrals daily. Provided consultation services to other departments or organizations regarding clinical matters.
- Coordinated with patient's case managers for patient transfers and future scheduling.
- Created and modified 12 provider templates weekly meeting 6-week access to care standards.
- Updated enrollee data using EMR
- Delivered patient-centered customer service; earned 92% performance rating.
- Provided direct supervision of clinical staff, including orientation, training and development of employees.
- Maintained accurate documentation of client progress within the Electronic Health Record system; updated enrollee data using EMR.
Education
Bachelor of Arts - Health Care Administration
University of Arizona Global Campus
01.2012
Associate of Applied Science - Physical Therapy Assistant
Community College of the Air Force
02.2006
Skills
- Medicare Claims Adjudicator/Processor
- UB-04/CM-1500
- Teamwork and Collaboration
- Type 45WPM
- Customer service skills
- Data Entry skills
- Front/Back Office Admin
- Electronic Medical Records
- Medical transcription
- Call center experience
- Military Experience
Accomplishments
- Managed care of clinics attaining award of Air Force Surgeon General "Best Clinic".
- As sole clinic referral reviewer recaptured 22.6K appointments avoided $1.7M in outsourcing.
Timeline
Medical Claims Processor Remote
BC Forward (Contract Agency)
07.2022 - 09.2023
Records Management Specialist II, Remote
Remedy Intelligent Staffing (Temp Agency)
04.2021 - 04.2022
Executive Admin Assistant
DFAS
07.2018 - 12.2020
Clinical Supervisor, Physical Therapy
DFAS
07.2015 - 07.2018
Bachelor of Arts - Health Care Administration
University of Arizona Global Campus
Associate of Applied Science - Physical Therapy Assistant
Community College of the Air Force
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