
Dedicated Reimbursement Specialist with exemplary analyzation and negotiation abilities. Highly skilled in customer service and coverage evaluation. Specializing in Medicare Advantage insurance claims with a well-established knowledge of the general industry.
· 1 year of experience verifying insurance information, analyzing medical information and updating the data from insurances, analyzing claims and making disputes and appeals to denied procedures.
· Specialist with Medicare Advantage Coverages.
· Experience training new hires.
· Knowledge managing requests from agents and dealing with disputes.
· Conducted audits on invoices, resolved exceptions, and handled customer correspondence
· Collaborated with cross-functional teams to establish and exceed department goals.
· Investigation and improvement of procedures to be more efficient following the client guidelines
· Quality reviewer to know if the agents are following the procedures correctly and providing the improvement plan to get that area of improvement.
· Provide support and guide to the agents to keep the Quality and productivity required
· Update process with the client to improve the areas of the job.
· Analyze the payment sheet for the agents to get pay correctly.
Microsoft Excel proficiency
Insurance Verification
Claims Processing
Medicare knowledge
HIPAA Compliance
Healthcare Reimbursement
Appeals Handling
Eligibility Verification
Microsoft Office
Teamwork and Collaboration
Customer Service
Critical Thinking