Healthcare Insurance Administration over 20 years’ experience. Medical Claims Supervisor, Claims (SME), Team Leader and Claims Processor, Claims Technical Coach, Auditor and Fraud Specialist. Medical and Benefits Enrollment, Technical knowledge of medical insurance, Coding, Health plan Policy and Procedures including Medical and Pharmacy (RX) claims, HMO, PPO (manage care), Medicare, Medicaid and Third-Party Payer regulations, Coordination of Benefits (COB). User Acceptance Tester (UAT), Quality Assurance tester (QAT). Application Lifecycle Management (ALM) approval and defect entry. Electronic Data Interchange (EDI), Oracle, Sequel Query Language (SQL), Golden application to run test scripts Strong ability to multi-task, manage and train staff. Knowledge of Medical Billing, including but not limited to HCPCS, Current Procedure Terminology (CPT) and International Classification of Diseases coding ICD10 in a HIPAA-compliant environment. Familiar with the Employee Retirement Income Security Act (ERISA), CMS1500 and UB04 forms. Knowledge of Amisys, Scrum and Jira meetings, Rim's 1 and 2, and Facets System. Microsoft Office, Excel, and Word applications. OPTUM Encoder Pro for Payers Professional program. DST Provider pricing.
Listed skills include Claims Administration, Claim Analysis, Medical Coding, Claims, and 33 others.