YARITZA KENNEDY
Brooklyn,NY
Summary
Experienced Customer Service, Medical Claims Examiner and administrative professional. Maintains extensive medical and healthcare knowledge, terminology, and expertise. Exceptional analytical and issue resolution skills. Proficient in reviewing/summarizing claim data. Strong organizational, communication, and customer service skills.
Overview
18
18
years of professional experience
Work History
Medical Call Center Representative
338 RWDSU/UFCW
04.2007 - Current
- Proficiently manage incoming telephone call inquiries from members and providers regarding claim status
- Act as liaison between Union, its current and potential members, and networking providers
- Independently conduct research to troubleshoot issues, effectively resolve concerns, and manage inquiries
- Demonstrate active listening skills by using good judgment to understand concerns and problem solve
- Routinely navigate a variety of desktop applications and software, responding to member and provider requests
- Perform issue resolution by exploring alternative solutions, implementing corrective measures
- Adequately utilize specific call scripting to ensure calls are handled per process design, based on call type
- Effectively handle confidential and sensitive personal and medical information, following HIPAA guidelines
- Accurately summarize communications and transcribe call notes regarding inquiries, updates, and resolutions
Medical Claims Examiner
09.2010 - 09.2013
- Resolved medical claims, approved and denied documentation, calculated benefits due and initiated payments
- Skillfully validated claim information on all medical claims from patients seeking payment
- Performed subsequent auditing and handling of claims and appeal requests including processing
- Tracked, documented, reported, and dispersed findings and recommendations
- Properly documented medical claims actions by proficiently completing and submitting forms, logs, and records
- Collected, analyzed, and summarized data and information to compile and prepare detailed reports
- Accurately read and assessed medical documents and communicated with members and physician offices
- Studied provisions of policy and certificates to make determinations regarding covered medical insurance losses
- Responsibly assembled information from physicians, employers, hospitals, and other insurance companies
- Initiated and conducted investigations of questionable claims, identifying coverage, and benefit options
- Rejected and accepted documentation, determined benefit due, and initiated denial or payment process
- Examined medical treatment records, property damage, and medical bills to understand overall extent of liability
- Used software to enter claim payments and performed concise, accurate, and sufficient file documentation
- Proficiently maintained claim files, including settled claims, and managed claim inventory for detailed analysis
Customer Service Representative
Aegis Communications
12.2005 - 04.2007
- Efficiently provided assistance to Medicare Part D prescription drug plan members
- Provided account information for pharmacy claims and maintained member inquiries and status records
- Utilized multiple healthcare databases to coordinate members insurance benefits.
Education
High School Diploma -
Brandon High School
Brandon, FL05.1998
Skills
- COMPUTER SKILLS
- Microsoft Office Suite: Excel, Outlook, and Word Microsoft Teams
- HPS Electronic Medical System Ingenix
- ICD-10 CPT Coding Docuware MAC Applications Novus
- OTHER SKILLS
- Data Verification
- Data Analysis
- Electronic Medical Records
- Call Coordination
- Provider Relations
- Customer Relationship Management
- Customer Service
- Quality Assurance
- Call Control
- Data Entry
- Complaint Resolution
- Answering Questions
- Data Gathering
Timeline
Medical Claims Examiner
09.2010 - 09.2013
Medical Call Center Representative
338 RWDSU/UFCW
04.2007 - Current
Customer Service Representative
Aegis Communications
12.2005 - 04.2007
High School Diploma -
Brandon High School
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