Authorization An benefits Specialist

Rate, USD
$21 / hour
Work schedule
Full Time,
Language skills
English
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About me

overall knowledge of authorization, benefits and claims processing for insurance companies and plans both private and government.


Professional area



Education

2007-2010 Medical Office @ Kaplan college

Associate’s degree in Medical Office Management/Administration


Experience

06/2023-01/2024 Authorization An benefits Specialist @ OrthoArizona

overall knowledge of authorization, benefits and claims processing for insurance companies and plans both private and government.
the ability to make decisions, assess and resolve problems effectively.
ability to carry out assignments independently, work form procedures, and exercise good judgment.
ability to maintain the confidentiality of all records.
ability to manage multiple tasks and demands given tight time constraints while ensuring a high degree of accuracy and attention to detail.
Effective interpersonal skills in a diverse population.
use a computer for extended periods of time.
Proven effectiveness in verbal and written communication with the team, department and other
overall knowledge of claims and authorization processing for insurance companies Including private, commercial and government carriers.

09/22-07/2023 Claims Representative @ Bright HealthCare

Processing of professional and facility medical services claims by reviewing and inputting data into the claims payment system using standard policies, procedures and guidelines.
Reviewing documents for accuracy
Entering payments
Keying data into the computer and providing excellent customer service to Providers inquiring on payment status
Maintain files and archives of billing documents. Assist with opening, date stamp and distribute mail
Processing daily tasks; accurate data entry
Work with physicians to ensure claims are resolved in a prompt, fair and courteous way.

03/2021-05/2022 Medical Claims Examiner @ Department of healthcare services

Reviewing documents for accuracy
Entering payments
Keying data into the computer and providing excellent customer service to Medi-cal Medicare providers inquiring on payment status
Maintain files and archives of billing documents. Assist with opening, date stamp and distribute mail
Processing daily tasks; accurate data entry
Work with policyholders, physicians, attorneys, contractors and others to ensure claims are resolved in a prompt, fair and courteous way.
Explain policy coverage to policyholders and third parties.
Complete thorough investigations and document facts relating to claims.
Determine the value of damaged items or accurately pay medical and wage loss benefits.
Negotiate settlements with policyholders and third parties.
Resolve claims, which may include paying, settling, or denying claim’s

02/202-01/2021 EMS/First Responders Claims Compliance auditor @ Wittman Enterprises
03/2019-01/2020 Team Leader/Supervisor @ Blue Cross Blue Shield of Michigan

Working in a high call volume call center
Mange a team of 23
Making sure reps will make there adherence an set goals for the month
Enforce policy an procedures
Work with members, doctors, an other insurance companies an collection companies
Take supervisor calls
Completing inventory for incomplete service forms
Have knowledge of medical billing, claims, reimbursement requirements and procedures
interpret various types of Explanation of Benefits and Remittance Advice
listen effectively to determine nature of inquiry from callers; ability to remain calm under stressful situations
Multi-tasking skills
Time Management


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