North Highlands CA 95660
A Position as Claims Analyst.
Highlights of Qualifications:
- Basic knowledge of government agency and insurance company programs, NAIC coordination of benefits guidelines
- A great deal of experience in claims and financial concepts
- Extensive knowledge of CPT, ICD-9, HCPCS and UB04
- Familiar with Health care insurance and medical coding
- Strong oral and written communication skills
- Familiar with billing and payment guidelines
- Strong interpersonal skills, reading comprehension and analytical ability
- Proficient in Microsoft Office (Excel, Word, Outlook) and relational databases
- Ability to build good relationship with customer
Excellent analytical and critical thinking skills
Claims Analyst, August 2005 – Present
Molina Healthcare, San Diego, CA
- Proficiently reviewed claims for completeness and approves and denied payment using established guidelines.
- Documented clearly and concisely claims adjudication decisions in Claim Notes.
- Identified potential system problems and claims training issues.
- Attended departmental training when required.
Claims Analyst, May 2000 – July 2005
Phoenix Health Plan, San Diego, CA
- Performed and conducted research on claims inquiries and reprocess claims.
- Recovered and retrieved funds from providers due to overpayment and adjusted provider claims for overpayment and underpayments.
- Performed effective research on larger projects and major reconciliations.
- Developed and maintained an efficient and accurate system to advancing newborn claim payments when eligibility information from the State is delayed.
- Monitored and determined claims accuracy using available claims editing tools.
- Assisted supervisor in the review of various claims reports.
High School Diploma, Waverly High School, Waverly, IL