In my current position my duties are as followed but not limited to•Processing Medical and Hospital claims according to procedures and guidelines. •Determine the amount of money if any should be paid on the claim•Deny claims that are not submitted properly or lacking information. •Send letters to appropriate parties for needed information. •Process claims in a timely fashion per prompt pay guidelines •Maintain up to date processing guidelines

My current position my duties are as followed but not limited to•Coding member submitted claims using ICD9, CPT and HCPC references and also Facets and Macess (systems)•Data entry of claims and correspondence•Sort and batch claims •Sort and batch correspondence. (Some examples of correspondence are Provider correspondence, Applications, and Member correspondence)

Sort and batch provider correspondence to get ready for scanning•Data entry of both claims and correspondence using Form Works (data entry system)Past Experience - St. Paul Travelers Fall River, MAI started in an entry level position and progressed to a supervisory role in which I was responsible for 17 people. Job duties•Scanning Preparation•Scanner Operation•Data Entry•Claim Match—matching bills to existing claims•Provider Match—matching bills to the correct Provider or Vendor•Provider Exception—investigating and solving difficult Provider Match situations.•I handled the Texas Error Report which is an error report provided by the state of TX. •Monitored and delegated workflow for 17 employees to achieve our daily objective.•Trained new and existing employees in job functions and new guidelines for processing•Was part of team that would find new ways of processing and then would help to implement the changes. I was also a part of 2 call center teams which assisted Providers with claims issues and a catastrophe call center for victims who suffered and event i.e. hurricanes, floods, tornados etc. Courses completed: Communicating with difficult peopleHandling difficult peopleExcel- level 1Knowledge is StrategyBehavior-Putting your best foot forward How to improve your image.

My responsibilities included but were not limited to, training new employee's, quality control, processing and updating policies.