North Highlands CA 95660
Claims Adjudicator with excellent skills and the ability seeking to work for your company.
Highlights of Qualifications:
- Excellent experience in processing claims for general accounts
- Sound knowledge of insurance procedures and accounting processes
- Profound knowledge of management utilization techniques
- Ability to multitask and maintain accuracy in high pressure environment
- Ability to coordinate with team members for various activities
- Familiarity with claims processing, accounts payable, general accounting
Northwest Community Hospital, Lansing, MI
August 2012 – Present
- Monitored various inputs from physicians such as x-ray and dental records.
- Evaluated referrals and provided authorization for claims.
- Managed claim system and provided information to new providers.
- Coordinated with IT team for upload and obtained required DDE rates.
- Generated remittance notice when required and obtain authorization from management.
- Coordinated with departments and assisted in transmission of claim files.
Valence Health, Lansing, MI
May 2009 – July 2012
- Adjudicated various medical and non-medical provider claims and updated on CMS.
- Procured rate tables for Medicare processes and monitored expenses.
- Maintained and generated accruals for accounting processes.
- Evaluated plans and maintained notes of patient records.
- Coordinated with providers and carrier contracts for authorization.
- Performed research and facilitated processing of claim payments.
Bachelor’s Degree in Finance
Edward Waters College, Jacksonville, FL