Dedicated claims specialist with over 5 years of experience in healthcare claim adjudication, medical coding, and customer support. Skilled at ensuring compliance, accuracy, and quality in high-volume environments while maintaining excellent communication and problem-solving abilities.
Expertise in analyzing, reviewing, and adjudicating healthcare claims in accordance with industry standards.
Proficient in applying CPT, ICD-10, and HCPCS codes for accurate claim review and reimbursement determination.
Handled customer inquiries and provided clear guidance on benefits, orders, and account issues.
Ensured HIPAA compliance in handling sensitive health and personal information across roles.
HCS Corporation
Analyze and adjudicate complex healthcare claims for Blue Cross Blue Shield members, ensuring compliance with plan benefits, regulatory standards, and provider agreements., Conduct detailed reviews of medical billing codes (CPT, ICD-10, HCPCS) to determine appropriate reimbursement and claim...
Kelly Services
Process and adjudicate high volumes of medical claims in accordance with health plan policies, CMS guidelines, and provider contracts., Investigate and resolve complex claim issues, including coordination of benefits, billing discrepancies, and provider inquiries., Interpret medical coding (CPT,...
ResultsCX
Handled high-volume inbound calls while providing clear guidance on benefit eligibility, product availability, and order placement., Resolved customer issues related to orders, benefit balances, product substitutions, and delivery concerns., Maintained HIPAA compliance and data privacy standards...
Smoothie King
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