Nyjaia Whosendove
Aiken
Summary
Demonstrated expertise in medical claims processing, with a strong ability to manage and resolve complex claim issues. Proficient in the use of advanced claims management systems to ensure accuracy and efficiency in processing. Well-versed in compliance regulations, with a consistent focus on maintaining thorough and precise documentation.
Overview
5
5
years of professional experience
Work History
Medical Claims Specialist
UnitedHealthcare
Remote
04.2024 - Current
- Managed high volume of claims, consistently meeting deadlines without compromising accuracy or quality.
- Identified opportunities for cost savings by analyzing medical billing patterns across various departments.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
- Conducted regular audits of processed claims to identify areas for improvement and potential fraud risks.
- Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.
- Verified patient insurance coverage and benefits for medical claims.
- Evaluated medical claims for accuracy and completeness and researched missing data.
Insurance Verification Specialist
Teleperformance USA
Remote
05.2023 - 04.2024
- Deliver exceptional service to our high value customers by
- Maintain accurate records of verification processes in electronic systems.
- Conduct insurance verifications to confirm patient eligibility and coverage details.
- Process pre-authorization requests for medical procedures efficiently.
- Updated patient records with accurate, current insurance policy information.
- Complied with HIPAA guidelines and regulations for confidential patient data.
Direct Support Proffesional Supervisor
Allorica
Remote
11.2021 - 03.2023
- Oversaw daily operations, ensuring compliance with company policies and procedures.
- Trained and mentored staff to enhance performance and improve customer service quality.
- Implemented process improvements that streamlined workflows and increased team efficiency.
- Monitored key performance indicators to identify trends and drive operational enhancements.
- Coordinated cross-functional teams to resolve issues and maintain high service standards.
- Conducted regular performance evaluations, providing constructive feedback to team members.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Demonstrated commitment to the organization''s core values, leading by example and fostering a culture of excellence.
- Increased customer retention rates by implementing customer feedback into actionable improvements.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Established team priorities, maintained schedules and monitored performance.
- Leveraged data and analytics to make informed decisions and drive business improvements.
Education
High School Diploma - Curriculum
South Aiken High School
Skills
- Critical Decision-making
- Medical terminology
- Insurance claims processing
- Medical record review
- EOB analysis
- Claim appeals handling
- Payment posting
- Industry networking
- Medical billing
- Provider relations
- Insurance verification
- ICD-10 proficiency
- Medicare expertise
- Claims processing
- Electronic health records (EHR)
- Patient confidentiality
- Eligibility determination
Timeline
Medical Claims Specialist
UnitedHealthcare
04.2024 - Current
Insurance Verification Specialist
Teleperformance USA
05.2023 - 04.2024
Direct Support Proffesional Supervisor
Allorica
11.2021 - 03.2023
High School Diploma - Curriculum
South Aiken High School