UnitedHealth Group

-Works closely with claims processors, claims teams, and supervisors as a subject matter expert to improve individual and team quality, technical skill set, and efficiency through coaching.
-Creates meetings for processors to discuss complex claim scenarios and provide training when necessary.
-Assists as an on-call SME for rework claim processes. 
-Responsible for creating training materials and PowerPoint presentations, claim demonstrations, and document updates to team and leadership. 
-Answers 25-35 complex processor questions weekly, as well as 10 training sessions per week that processors can sign up for 30-minute intervals for claim assistance.
-Summarizes claims analysis for possible solution recommendations and identifies trending issues for training opportunities.

Claim Business Process Analyst

- Completes necessary adjustments to claims, confirming the proper benefits are applied to each claim (e.g., processing procedures, state mandates, CMS/Medicare guidelines, and benefit plan documents)
- Responsible for reviewing documentation submitted by providers and verifying if claims are processed correctly. 
- From November 2022 through October 2023, I reviewed 1,133 claims with two errors found for the MAP period for a quality result of 99.82%
- Responds to provider inquiries from the call center or appeals documentation and solves issues through investigation.
- Assisted in coaching/training new hire teams to learn all aspects of rework claims adjusting, understanding department goals, and following best practices for processing. Has mentored several employees post-training, providing additional support as needed.

Claims Adjustment Representative (Physican/Hospital)

- Provided expertise and general claims support by researching and investigating physician claim reviews. 
- Analyzed complex health care claims to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment.
- Maintained a weekly metric goal of processing 13-15 claims per hour (VPH) 
- Utilized a wide variety of software and systems to process claims.
- Developed and fine-tuned performance skills while keeping claims quality rate above 99%.
- From November 2021 through October 2022, I reviewed 5,908 claims with five errors found for the MAP period. This averaged to a quality result of 99.92%.

Associate Claims Representative

AmerisourceBergen

- Collected and reviewed all patient insurance information needed to complete the benefit verification process. 
- Consistently maintained high quality with insurance calls and data entry, resolving around 20 patient accounts daily.
- Assisted with overtime hours to manage high inventory.
- Identified any benefit restrictions and details on how to expedite patient access. Job included documenting and initiating prior authorization process, claims appeals, etc.
- I extended a 3-month contract to nearly 12 months on board due to my work efficiency and exceptional quality.

Insurance Benefits Specialist

Oakwood Dental Arts

- Answered phone calls and scheduled appointments for 6 different branch offices. Average of around 70-80 inbound/outbound calls daily. 
- Provided customer service care and resolved patient issues such as insurance and billing problems.  
- Checked new patient eligibility and reviewed pre-approvals from various insurance plans. 
- Proficient in Dentrix and other patient scheduling software systems.

Call Center Specialist

Advanced Implant & Oral Surgery

- Responsible for checking in patients, entering new patients into system and making appointments for extractions and sedations, implants, sinus lifts and other oral surgery procedures.
- Job included collecting and entering payments into system, checking multiple insurances, and answering phones. 
- Responsibilities also included billing all charts by end of day and attaching appropriate documents.

Front Desk Receptionist / Dental Biller

Employer Installation Specialist @ UHG | Investigator & Researcher | Passion for healthcare | super cat person 🐈

Hi! I'm a highly efficient medical claims adjuster and organized informational investigator with claims processing and error analysis skills. With over five years of healthcare experience, I solve complex provider/member issues through intensive research and claim auditing. I aim for continuous improvement and hold the highest standards in my work, as I have constant quality results of 99.82%. 

In my free time, I love to read, watch scary movies, meditate, play fantasy games, and hang out with my two cats! 🐱

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