210 Hall Place
Texarkana, TX 75507
Job Objective Searching for work as a Claims Auditor with company seeking a hard working dependable employee.
Highlights of Qualifications:
- Remarkable claims examining experience in a managed care environment
- Good knowledge of DMAP, Medicare, and Medicare Advantage benefits and protocols
- Comprehensive knowledge of ICD-9, CPT, HCPCS and Family Care’s claims policies and procedures
- Remarkable experience in interpreting Health Plan Division of Financial Responsibilities (DOFR)
- Ability to create reports using data gathered from audits
- Ability to build and improve the claims processes
- Excellent organizational skills
- Proficient with MS office tools and claims software applications
- Ability to work in an environment with diverse individuals and groups
- Excellent written and verbal communication skills
Claims Auditor, August 2005 – Present
Nautilus Healthcare Management Group, Texarkana, TX
- Identified underpayments/overpayments and generated periodic reports.
- Performed to resolve errors by communicating with the Production Manager or Supervisor.
- Audited member liability denials to assure quality of claim.
- Managed to generate accurate claim payments and reimbursement calculation of applicable fee schedules.
- Provided tools and recommendations to avoid overpayments.
- Ensured compliance with health plan requirements.
Claims Auditor, May 2000 – July 2005
XL Health, Texarkana, TX
- Identified problems, troubleshoot, and provided guidance to claim analyst.
- Conducted daily review of pending claims and prepared weekly audits for each claim.
- Contributed to the development of claims analysis reports.
- Reviewed claims to ensure that claims are appropriately processed.
- Ensured that denied and underpaid claims are timely reprocessed.
- Computed and corrected claim errors in the Facets system.
Bachelor’s Degree in Business Administration, Thomas Jefferson University, Philadelphia, PA