Baton Rouge Claims Specialist
Resume:
Jessica Brown
Baton Rouge, LA *****
***********@*****.***
A dedicated and enthusiastic individual with a desire to learn in seeking an opportunity that utilizes my organizational, time management and computer skills. Authorized to work in the US for any employer
Work Experience
Clinic billing specialist
Baton Rouge General - Baton Rouge, LA
October 2022 to Present
Preparing and submitting billing data and medical claims to insurance companies. Ensuring each patients medical information is accurate and up to date. Preparing bills and invoices and document amounts due to medical procedures and services.
by overseeing outstanding balances and assessing unpaid claims, expedite the billing process to ensure timely payment, research denials and resubmit claims, as needed, conduct billing audits, and compile reports.
Denials, Bundling in Medical Billings
Understanding CPT Codes, Dx codes
Fully Insured Claims Specialist
Fully Insured Claims Specialist
Blue Cross Blue Shield - Baton Rouge, LA
January 2022 to November 2022
• Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctly.
• Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
• Researches and resolves claims edits and deferrals. Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicable. Customer Service Representative
Atrium Health - Charlotte, NC
January 2021 to January 2022
• Set up client appointment
• Assisted customers with a warm and professional attitude
• Answered general questions
• Provided policy and service information
• Epic
• Scheduling
• Facets
• claims
ROI Specialist
ScanSTAT Technologies - Houston, TX
January 2020 to January 2021
Respond to phone calls from medical and support personnel requesting medical records or patient identification to be read from the record. • Log medical record requests into MRO database. • Determine records to be released by reviewing requestor information in accordance with HIPAA guidelines and obtaining pertinent patient data from various sources, including electronic, off-site, or physical records that match patient request. Scan medical records into MRO database. • When required, respond to walk-in customers requesting ROI information and log information provided by customer into MRO database. • If necessary, respond and process requests from physician offices on a priority basis and fax information to the physician office. • Comply with site facility policies and regulations. • At specified sites, responsible for handling and recording cash payments for requests. • Escalate issues to manager that delay timely release of records. Dental & Vision Claims Processor
Starmount Life Insurance - Baton Rouge, LA
June 2018 to December 2019
Dental claims processor
Provide timely processing and adjudication of claims. Prepare documents and other paper work relating to claims. Take responsibility of payment of all claims in compliance with rules. Respond to inquiries and resolve pertaining to specific claim issues. Maintain working relationships with departments processing claims. Handle claims involving loss due to fire, lightning and theft. Assist staff in processing complicated claims.
Handle claims related to Dental.
• Process incoming Medicaid claims in accordance with policies, procedures, and guidelines
• Post insurance and patient payments, utilizing correct denial codes for proper account management
• Verify presence of all required data fields and those applicable medical records are included/reviewed
(where required)
• Communicate with physician offices to obtain additional information required to resolve edits and/or to appeal denied claim
• Refer claims for medical claim review as necessary/applicable
• Work effectively in a virtual, work-from-home, telecommute position processing claims. ROI Specialist
Baton Rouge Clinic - Baton Rouge, LA
November 2015 to April 2018
• Managed Incoming calls or incoming post services Medicaid claims work
• Provided on-site Release of Information services
• Developed, Monitored, and Revised the member's service plan
• Greeted walk-in customers
• Received incoming request including opening mail, telephone inquiries, and retrieving facsimile inquires, depending on needs to the client
• Performed quality checks on all work to assure of the release, confidentiality, and proper invoicing
• Obtained intake (demographic) information from callers
• Conducted a thorough radius search in Provider Finder and followed up with provider on referrals given
• Navigated through multiple systems Electronic Health Information and FACETS
• Responded to telephone and written inquiries from clients, providers and in-house departments
• Created spreadsheets in Excel
Baton Rouge LA Office Administrator
Pin & Associates
December 2013 to October 2015
Managed front desk
● Provided assists helping customers apply for Medicaid and job search
● Planned, coordinated, and conducted a career plan for customers and other activities, in accordance with corporate guidelines
● Created various spreadsheets within Excel for reporting
● Developed, prepared, and delivered career preparation plans
● Reviewed and audited all assigned areas regularly for contractual
● Maintained documentation and training records for each client using CIS, as well as other systems of documentation
● Performed data entry, typing, word processing, record-keeping and correspondence letters to clients Lead Care Manager
Sunrise Senior Living - Baton Rouge, LA
March 2011 to November 2013
Managed development of the Individualized Service Plans (ISP) and monthly updates
● Followed adjudication policies and procedures to make sure residents were properly cleaned
● Managed a designated group of residents during their shift
● Partnered with community team to ensure community is in compliance with OSHA requirements and promotion of Risk Management programs
● Managed and updated residents' charts
● Performed data entry, typing, word processing, record-keeping and correspondence letters
● Administered medications to patients
● Committed to serving our residents and guests through Principles of Services Education
High school diploma
Christa Mcauliffe Learning Center - Baton Rouge, LA May 2004 to August 2004
Skills
• EXCEL
• OUTLOOK
• MICROSOFT WORD
• WORD
• DATA ENTRY
• EOBS
• BILLING
• FAXING
• MEDICAL RECORDS
• MEDICAID
• CLAIMS
• MEDICAL MANAGEMENT
• MEDICARE
• MEDICAL INSURANCE
• MEDICAL TERMINOLOGY
• COLLECTIONS
• SHAREPOINT
• EHR
• EPIC
• SCHEDULING
• Customer Support
• Customer Service
• Customer Care
• Call Center
• CSR
• Health Insurance
• Hcfa
• EMR Systems
• Word Processing
• Medical Office Experience
• ICD-10
• Insurance Verification
• HIPAA
• Microsoft Excel
• Basic math
• English
• Microsoft Office
• Multi-line phone systems
• Computer Skills
• Patient Care
• Medical Billing
• Documentation review
• Medical scheduling
• Typing
• Research
• 10 key typing
• Medical collection
• Communication skills
• ICD-9
• Clerical Experience
• ICD-10 (4 years)
• Microsoft Access
Certifications and Licenses
CPR Certification
Assessments
Work style: Reliability — Proficient
January 2022
Tendency to be reliable, dependable, and act with integrity at work Full results: Proficient
Scheduling — Proficient
June 2022
Cross-referencing agendas and itineraries to avoid scheduling conflicts Full results: Proficient
Customer focus & orientation — Proficient
October 2021
Responding to customer situations with sensitivity Full results: Proficient
Customer service — Proficient
June 2022
Identifying and resolving common customer issues
Full results: Proficient
Medical receptionist skills — Proficient
June 2022
Managing physician schedules and maintaining accurate patient records Full results: Proficient
Call center customer service — Proficient
January 2022
Demonstrating customer service skills in a call center setting Full results: Proficient
Medical terminology — Proficient
June 2022
Understanding and using medical terminology
Full results: Proficient
Attention to detail — Proficient
January 2022
Identifying differences in materials, following instructions, and detecting details among distracting information
Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
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