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tTo obtain employment within the accounting, financing and healthcare industry that provides the highest quality service

FAIRFAX, Virginia - US

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  • Job Target: sr claim representative
  • Employment Status: Employed - Will Consider Right Opportunity
  • Experience Level: Not Specified
  • Seeking: Full-Time
  • Industry: Accounting/Finance Resumes
  • Salary: neg
  • Degree: Not Specified
  • Security Clearance: None
  • Travel: None
  • Relocate:: No

Objective

Sixteen years work experience in medical area, which had given me a chance to learn multiple tasks within a company in order to enhance my skills in adjustment, repricing, data processing and auditing

Job Target

sr claim representative

Professional Experience

2007 – 2008 QUADRAMED/INOVA
DATA ENTRY

Merge, consolidates or inactives patient or person records, demographics master files of Alexandria, Mount vernon, Fairfax, Fair-Oaks hospitals. Documents self productivity daily and administrative duties. Self- proof and edit patient account and work-flow

1990 – 2007 NCPPO/WELLPOINT
SR CLAIMS REPRESENTATIVE

Senior accounts payable,Senior medical specialist claims repricing

Senior Claims Representative

Repricing hospital claims and Dr's claim according to provider contracts

Run checks, audit the payment claims

Process payment in Netpay system

Prepare daily production reports that show workflow process

Research claims status

Maintain underpayment request

Meet department requirements of my job title.

Processed between 300-500 claims perday

Handled priority items for management

Processed electronic submitted claims for individual group insurance company

Manually processed particular types of claims according to provider contracts

Trained associates in all areas of the claims process

Prepared work assignments for other associates to assist team leader

Provided the highest quality of customer service at all times

Prepared reports for management team

Prioritized workflows to better serve the customer

Received telephone inquires regarding claims status

Made outgoing calls to check status of claims with multiple insurance carriers

Organized reports to assure customers would receive all documented informantion for

our system in a timely manner

Currently update provider records

Make necessary changes and terminations to provider records

Creates monthly reports for the management team regarding new provider status

Log work in and out of an excel spreadsheets on a daily basis

Meet 98% accuracy levels each month for data processing

Assits with internal emails regarding contracts

Handle necessary projects as assigned to help update the system accordingly.

1989 – 1990 MClean Rental
Accounting Clerk

Collected checks from other branch in order to assit in bookeeping duties, deposits, payment, filling, mailing

Education

2009 Northern Virginia Community College
– Associate or Vocational Degree (AA/AS/MCSE/etc.)

completed 59 credits in accounting major

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Last updated on: 2009-07-22.