Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Pragmatic Insurance Verification Specialist touting years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.
● Managed state and local government agencies (Medicaid agencies, transit authorities, school boards), managed care organizations and hospitals for the states of Ga, FL, MI,CT &SC
● Sent out emails, notifications and all corresponding letters Knowledge of Medicaid guidelines and covered services
● Sent out emails, notifications and all corresponding letters
● Scheduled interviews, meetings and travel arrangements for
the VP of HR
● Processed leave of absence request
● Drafted rejection letters and acceptance letters
● Verified employee time for payroll processing
● Maintained office supplies
● Handled invoices for all vendors
● 10 years High Volume Call Center Experience
● Medical claims processing Insurance authorization & eligibility
● Medicaid and Medicare knowledge, Medical Terminology, ICD-
10 Proficiency
EOB Analysis Medica,l record review and
● HIPAA knowledge FMLA, EEO, Employment Law and the ADA
● Skilled in orienting new personnel, administering HR policies &
procedures, and recruiting & training staff, job posting
● SAP, EV5 Enterprise Systems, SharePoint, Kronos, Lotus Notes,
Microsoft Office Suite, CRM Tools, People fluent, Taleo,
PeopleSoft
● Microsoft Teams, Zoom, Slack, Skype, Zendesk, Fintech