IEHP - Claims Configuration Specialist Resume Example

Customize this Resume

Alexander Wilson

XXXX XXX XXXXXXXXX XX

Highland, CA 92346

Ph: XXXXX XXXXXXXX

XXXXXXXXXXXXXXXXXXXXXXX

Professional Summary

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 2012－Present 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 2012－Aug 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 2006－Oct 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 1998－Sep 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

Love this resume? Customize this Resume

Data Entry Patient Account Representative Medical Biller

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

                                

Similar Resumes