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IEHP - Claims Configuration Specialist Resume Example

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Alexander Wilson
XXXX XXX XXXXXXXXX XX
Highland, CA 92346
Ph: XXXXX XXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXX
Professional Summary

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Dedicated Claims Configuration Specialist . Looking for a position as Claims Configuration Analyst 1 in a fast growth company.

Skills
  • Customer and Personal Service
  • Clerical
  • Active Listening
  • Coordination
  • Time Management
  • Critical Thinking
  • Complex Problem Solving
Experience
Claims Configuration Specialist Aug 2012Present IEHP Rancho Cucamong, CA
  •  Claims Configuration Processor: 08/2012 - 09/2014.Log Pinks and assigned them to configuration  specialist if needed or any other projects for our department.
  • ERRVU analyze claims data and recommended to Analyst to reconfigure.  
  • RCHC Provider Build and ERRVU
  • TIN Verification validate TIN with the IRS.
  • Returned Checks
  • Configured OBGYN and Vision Contracts.
  • Configured Non Contracted Providers.

10/2014 to Current

  • Configuration of:
  • Member LOA's
  • Blanket LOA's
  • BH Contracts
  • Specialist Contracts
  • Specialist Emails
  • Training Configuration Specialists
  • OBGYN Contracts
  • Vision Contracts


 

Data Entry Feb 2012Aug 2012 T&T Staffing Rancho Cucamonga, CA
  • Intup necessary changes to update member eligibility. Performed date projects for Medicare Department updating member information, requesting Insurance card and filing.
  • Review analyze correspondence received.
Patient Account Representative Jun 2006Oct 2010 Canfield and Associates a PHNS Co On Assigment Employment Agency Cerritos, Ca

  • Process claims to conclusions upholding company policy and assuring customer satisfaction. Audit  and follow up aged accounts, Review the terms of the contract with the payers.
  • Analyze and  interpret explanation of benefits, Identify or apply contractual and administrative adjustments, responsible for reducing A/R, Handle heavy in and out bond phones calls, refunds, claims follow up from IPA/MG's. Knowledge of stop loss and stop loss language, Hospital systems: SMS. Citrix/Epic. Worked Hospital Systems for Providence Health Systems & Cedar Sinai Medical Center.
Medical Biller Nov 1998Sep 2004 USCB Inc Los Angeles, CA
  • Billed UB-92's pulled information requested from insurance Co such as Medical records, and/or EOB's to be billed out with the claim.
  •  CPT codes & ICD-9 Codes knowledge, Medicomm, HBOC, Access Excel, Word knowledge, Microfilm Records & EOB's, Office filing and Data Entry, review and analyze correspondence received, Customer Service, Worked Hospital systems for UCLA Medical Center.
Education
High School Diploma California High School Lynwood, CA
Certificate in Medical Billing-Coding and Medical Terminology Lynwood High School Program Lynwood, CA
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Resume Details

This is a real resume for a Claims Configuration Specialist in Highland, California with experience working for such companies as Iehp, T&t Staffing, Canfield And Associates A Phns Co On Assigment Employment Agency. This is one of the hundreds of Claims Configuration Specialist resumes available on our site for free. Use these resumes as templates to get help creating the best Claims Configuration Specialist resume.

Previous Companies:

  • IEHP
  • T&T Staffing
  • Canfield and Associates a PHNS Co On Assigment Employment Agency

Previous Job Positions:

  • Claims Configuration Specialist
  • Data Entry
  • Patient Account Representative
  • Medical Biller

Schools:

  • California High School
  • Lynwood High School Program

Level of Education:

  • High School Diploma
  • Certificate in Medical Billing-Coding and Medical Terminology

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