Provider Analyst/Claim Processor Resume Atlanta, GA - Hire IT People

SUMMARY:

7 years in Employee health care which include Healthcare Management, claims processing, claim adjustments and claim examiner.
Experience in consulting clients from diversified business domains such as Healthcare Insurance.
Ability to identify and resolve problems with established desk procedures.
Strong leadership and communication skills and the ability to work in a team environment while meeting deadlines.
Experiences with CPT codes and DX codes
Experiences applying basic math skills; Knowledge of Medical Terminology
Knowledge of corrected claims and billing procedures
Excellent skills understanding Clients needs and recommending the appropriate solutions.

TECHNICAL SKILLS:

Membership & Billing: Subscriber Enrollment

Facets: Benefits

Provider files: Claim adjustment

Gateway System: Pended Claims

Claim examiner: EPIC

Claim Auditor: CPT and DX codes

AMISYS: Provider credentials

PROFESSIONAL EXPERIENCE:

Confidential - Atlanta, GA

Provider Analyst/Claim Processor

Entered healthcare claims into EPIC data system
Updated provider files on EPIC system
Created Reimbursement tasks to support reimbursement policies
Verified Provider NPI number, tax ID and address to ensure proper provide contracts
Corrected and reviewed provider specialties and Groups
Corrected claims based on Provider resubmissions
Assisted with claims recoveries
Participated in team meetings to ensure appropriate business requirement
Performed audit of selected claims to ensure proper claim processing.
Researched Provider claims to recoup overpayments and requested refunds

Confidential - Birmingham, Alabama

Claim Processor/Adjustor

Processed Medical Claims by Medicaid and Medicare
Corrected improperly processed claims and recouped over payments from Provider
Processed medical, dental, Vision, Inpatient, Outpatient, Medicare, DME, COB and hospital claims using AMISYS and Gateway
Followed adjudication policies and procedures to ensure proper payment of claims
Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims
Adjudicated claims based on proper department
Logged telephone calls in system and followed up on issue.
Participated in meetings to ensure deadlines and procedures
Examined policies and guidelines to assure appropriate claim payments

Confidential - Detroit, Michigan

Claims Processor/Auditor

Processed claims forms while using Facet database.
Resolved problems resulting from claim settlement.
Followed adjudication policies and procedures to ensure proper payment of claims
Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims
Performed audit of selected claims to ensure proper claim processing.
Researched claim overpayments and requested refunds
Logged telephone calls in system and followed up on issue

Confidential - Scranton, Pennsylvanian

Facets Claim Processor

Processed medical, dental and Vision Claims on Facet systems.
Processed Inpatient, Outpatient, Medicare, DME and hospital claims using FACETS 4.87
Pended claims to correct departments to ensure proper payments
Created reimbursement tasks to recoup overpayment
Adjusted healthcare claims due to under and over payments
Reviewed deductibles, copayments, coinsurances and out of pocket for benefit and payment accuracy
Proceed and denied duplicated claims.