North Highlands CA 95660
To obtain the Medical Claims Processor position within your company and provide excellent service.
Highlights of Qualifications:
- Wide experience in data entry and medical claim processing
- Profound knowledge of codes applicable in CPT, HCPC, Revenue and ICD-9 systems.
- Deep knowledge of Red Book, ASC Groupings, DRGs, Health Maintenance Organization (HMO) and IPA claim payments adjudication.
- Familiarity about rules and regulations at DMHC and CMS.
- Proficient in submission and editing claims electronically and other on-line systems for claim processing and problem registration
- Skilled at decision-making, effective communication, analytical and research oriented tasks.
- Ability to process claims for surgery, radiology, lab and medicine for CMS 1500 and CMS 1450 claim forms
- Ability to comprehend DFRs and related benefits
Medical Claims Processor
Southwest Service Administrators Inc., Atlanta, GA
August 2007 – Present
- Engaged to input data into processing system after interpreting medical coding and knowing terminology used in medicine professions in respect to procedures and diagnoses.
- Ensured to process assigned claim forms and inspect apt allocation of co-pays, deductibles, reimbursements and co-insurance.
- Complied with all judgmental policies and processes to assure appropriate claim payments.
- Provided excellent customer service to all providers, members, insurance companies and billing department.
- Maintained written record of phone calls in system and adhered with issues as required.
- Solved all issues related to claim adjudication and customer complaints and queries as received over telephone.
- Researched and analyzed claim overpayments and funds requirements.
Medical Claims Processor
Benefits Administration Corp., Inc., Atlanta, GA
May 2004 – July 2007
- Ensured to take minimum assistance for processing complex claims.
- Researched and processed different sets of medical plans as well as benefits.
- Replied to inquires received in written format from participants and providers in relation to medical benefits.
- Entered medical claim related information into PCM application.
- Evaluated claim database which had been rejected earlier.
- Calculated apposite amount to be paid to recipient and processed crucial payment transactions accordingly.
- Performed and managed routine follow up activities.
Bachelor’s Degree in Health Care Management
Woodbury Institute of Champlain College, Montpelier, VT