Accomplished claims examiner with the ability to maintain a cheerful friendly attitude in a fast-paced environment, quick to adapt to new changes, independent worker, team player, increasingly above average customer service and satisfaction skills, excellent organizational skills with managing multiple assignments while meeting and exceeding department goals. Hands on experience with Absence Management, Disability, Arizona Social Security Medicaid and Medicare programs and requirements. Proficient use of medical terminology, ICD-9 and CPT coding, third party billing and HIPAA compliant. Solid computer skills in all applicable programs including the ability to type 50+ WPM/10-key.
WORK EXPERIENCE
Matrix Absence Management | Phoenix, AZ
Claims Specialist: December 2011 - September 2012
Intergraded claims examiner efficiently reviewed and analyzed short term disability claims in compliance with company policies and government regulations. Continually assess claim details to determine if claims are going to exceed case management authority guidelines. Ensure that every absent employee is qualified and notified of their benefits and communicate the details of what they are responsible for at the beginning of the claim. Provide subject matter expertise regarding preparation and distribution of various employee benefit communications, as required. Act as the liaison with the leave vendor for all customer service and process concerns. Coordinated benefits with management, employees and leave management vendors to implement initiatives to address needs for improvements in leave administration. Recognized daily for exceeding and meeting production goals established by management.
Arizona Department of Economic Security| Phoenix, AZ
March 2008 - December 2011
Disability claims examiner reviewing, and analyzing medical, psychiatric, and vocational evidence to determine eligibility for Social Security disability benefits. Provide professional courtesy interacting with advocates to explain and defend decisions and actions. Appointed single decision maker adjudicated qualified extremely severe medical conditions under compassionate allowance guidelines expedited benefit payment which drastically reduced the waiting period. Outreach to claimants, doctors, medical specialists, or employers to obtain any additional information resolving all open actions. Maintained a clean working environment with organized files adhering to confidentiality standards according to policy and procedure guidelines. Continually assess claim details to determine if claims were going to exceed case management authority guidelines. Recognized daily for exceeding and meeting production goals established by management in addition to maintaining a 97.8 percent annual quality assurance rating.
Mercy Care Plan Arizona Medicaid | Phoenix, AZ
October 2003- February 2006
Customer quality specialist utilizing independent judgment reviewing healthcare insurance reimbursement request. Ensure all demographic and eligibility information entered into the system was accurate and consistent with policies and procedure’s taking any disciplinary actions as needed. Recognized by management in providing professional etiquette and courtesy while interfacing with internal and external clients. Resolve any patient/customer complaints by identifying problems and coordinating appropriate corrective actions in a timely manner. Supervised accounts receivable functions, ensuring appropriate internal controls, timeliness, accuracy, and adherence to governmental policies were maintained. This includes providing that patient accounts are correctly billed to their appropriate payer and that revenue is properly recognized.
EDUCATION
Everest College | Phoenix, AZ
February 2003 - April 2004
Medical Insurance Billing and Coding, Claims processing/collection strategies, Current procedural coding,
Graduated with a 3.7 GPA and Perfect Attendance
