Objective To secure a position that offers career opportunities, expansion of my knowledge and immediate challenge.
Professional Skills • Microsoft Office
• Microsoft Windows
• Rims
• Lotus 1-2-3
• Riva
• PEAS • Filing/Editing
• Typing (45+ wpm)
• NDB/UNO
• Telephone Skills
• Nice System/COSMOS
• Emptoris • Stellent
• OCMS/EEDB
• Excel
• IDT
• Customer Service Skills
• Qfiniti
Education American Career College/Medical billing, Health Claims Examiner North Hollywood, CA
Cerritos Adult School/Accounting Certificate Cerritos, CA
El Camino College / Business Administration Torrance, CA
University of Phoenix /Business Management Gardena, CA
Employment Skills • Developed ability to work in a fast-paced atmosphere
• Maintained excellent customer relations and developed customer rapport
• Performs member terminations as noted on payment backup.
• Ability to follow instructions well and make decisions with no supervision
• Maintains timely, accurate documentation for all appropriate transactions
• Performs a variety of routine and non routine Billing and Reconciliation functions in accordance with standard procedures.
• Makes corrections and adjustments
• Effectively developed telephone communication skills and consistently met quotas
• Process High dollar stop loss claims/ Process 100 plus claims a day
• Applies interpretive rules associated with contract and claims processing
• Reviews and researches as necessary, claims inquiries, payment disputes, denial upholds and readjudication of claims if applicable
• Corresponds with providers, members and inter-office departments to process and resolve issues.
• Reviews appeals and complaints
• Experience with provider relations and/or provider contracting
• Responsible for overall provider contract and amendment loading and processing using various databases.
• Responsible for the installation and administration of assigned contracts, including, but not limited to: structure and billing set up, eligibility collection, database loading,
• Make benefit determinations and calculations of type and level of benefits based on established criteria and provider contracts
• Create Schedule A forms to meet Form 5500 filling requirements
• Ensures documentat...
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