Professional Summary Over 15 years of quality work performance and experience as a Medical Claims Analyst, processing claims, grievance and appeals, and adjustments, along with experience in Medical Insurance Billing and Coding. I have great accuracy, attention to detail including timeliness in managing production metrics while maintaining high quality. Successfully assisted in developing training materials to coach and to train others, in order to maintain high production in a goal oriented environment. Experience with various MMIS (Medical Management Information Systems), 6 + experience with EDI ANSI X 12 document file formats, and remittance of claims from medical practices and hospitals paying, denying, researching, processing and resolving members Medicare Part A, B, C, D/ Medicaid, DSNP and Commercial insurances claims including HMO and PPO. Analytically skilled with strong knowledge and coursework in Anatomy and Physiology, Medical Terminology, CPT-4, Diagnosis coding- ICD-9, ICD-10, DRG, HCPCS, using UB-04, CMS-1500. Experience in Plan benefit determination with copay and deductible limits and accumulators in Pharmacy, mental health, and vision. Experience processing In-patient, out-patient, Office, Labs, X-rays, Surgeries, Physical Therapy, Mental Health, Vision, ER. 10+ years in Medical Insurance, Enrollment, Plan Loading, Contract interpretation and benefit analysis. Over 5+ years' experience in supervisory and team leadership with management of up 15 to 30+ trainees and team members. In the process of studying for CPC certification (Certified Professional Coder) exam thru AAPC. 8+ years of call center customer service experience and leadership, 8+ years of Accounts Payable and Accounts Receivable 3 years in HR and benefit and contract interpretation. Proficient working knowledge of MS Office. Technically skilled and proficient in learning new software with experience in multiple software programs, X 12/EDI transaction sets formatting, processing and distribution of work, 810, 835, 837P, 837I, 850, 856, 860 files, IBM AS400, working knowledge and intermediate skills in Allscripts Practice Management, Amisys advance, HIMSS, CAS (Humana), Citrix, CMS (Illinois), CRM Software (FL), Diamond, Epic Resolute, Revenue cycle auditing and HB/PB Claims with Radiant/Cupid/MyChart tech support level 1 and EHR modules, Facets 4.7-5.3 claims processing, benefit and payment configuration, Enterprise Systems, GE/IDX Centricity with EMR, Macess, NextGen EMR/EHR, Oracle, PeopleSoft, SAP, STAR, SharePoint, Electronic Medical Records Software, and multiple document scanning and sharing software. MS Office Word, Excel, PowerPoint, Access, Visio, Claim processing and adjudication experience with Alaska, California, Florida, Georgia, Illinois, Iowa, Michigan, New York, Ohio, Oregon, and Washington State including Medicare and Medicaid

Highlights:

• Benefits
• Medicare
• Leadership
• Production Metrics
• Coding
• Data Entry
• system configuration
• Medicaid
• Commercial Insurance
• Analyst
• Epic Resolute
• Facets
• Centricity
• Allscripts
• Medical Claims Examiner
• Contract Analyst
• Benefit Analyst
• Medical Claims Specialist
• Medical Claims Analyst
• Insurance
• Claims Processor
• Processor
• Enrollment
• configuration