Experience

Anthem

• United States
• Insurance
• 700 & Above Employee

• Financial Operations/Claims

  • Nov 2017 - Present

  Hired as a level II as an outside candidate to recover overpayments from providers. I work through documentation to identify the overpayment and with speed and accuracy, adjust the payment accordingly. Hired as a level II as an outside candidate to recover overpayments from providers. I work through documentation to identify the overpayment and with speed and accuracy, adjust the payment accordingly.



Tidewater Kidney Specialist

• United States
• Armed Forces
• 1 - 100 Employee

• Medical Coder/Biller

  • Jun 2015 - Present

  Hired in June 2015 to handle billing. Moved on to inputting charges, while working the A/R and posting most of the payments for the practice. I also audited medical records to ensure the physician is using the correct code based on the criteria. I handle high level appeals and grievances presented by patients. Hired in June 2015 to handle billing. Moved on to inputting charges, while working the A/R and posting most of the payments for the practice. I also audited medical records to ensure the physician is using the correct code based on the criteria. I handle high level appeals and grievances presented by patients.



Geico

• Medical Payments Adjuster

  • Nov 2013 - May 2014

  Hired as one of only a few adjusters from outside the company to handle first party medicalpayments and personal injury claims. Received, keyed and processed bills efficiently whileensuring providers were billing per AMA guidelines. Responsible for setting up and preparingfiles for Independent Medical Exams, which included asking physicians about specific injuriesand their causality to an accident. Hired as one of only a few adjusters from outside the company to handle first party medicalpayments and personal injury claims. Received, keyed and processed bills efficiently whileensuring providers were billing per AMA guidelines. Responsible for setting up and preparingfiles for Independent Medical Exams, which included asking physicians about specific injuriesand their causality to an accident.



Optima Health

• United States
• Insurance
• 700 & Above Employee

• Group Benefit Analyst II

  • Nov 2005 - Aug 2013

  Received and processed medical claims from providers and facilities that were of higher dollaramounts with a perfect accuracy score. Responsible for ensuring that the claims were codedappropriately and were paid or denied correctly per AMA and Optima guidelines. Promoted tosenior processor and responsible for auditing other claims processors. Was asked to help update the policy several times with verbiage that was processor friendly. Received and processed medical claims from providers and facilities that were of higher dollaramounts with a perfect accuracy score. Responsible for ensuring that the claims were codedappropriately and were paid or denied correctly per AMA and Optima guidelines. Promoted tosenior processor and responsible for auditing other claims processors. Was asked to help update the policy several times with verbiage that was processor friendly.