Medical Claims Processor Resume

When writing a Medical Claims Processor Resume remember to include your relevant work history and skills according to the job you are applying for. Whether you're seeking an entry-level position or have been in your career for a few years, exposing your relevant achievements in your resume can allow you to stand out and get that job interview.

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Here is the Medical Claims Processor Resume example:

Elizabeth Landa

1152 Stroop Hill Road

Atlanta, GA 30309

(555)-555-5555

[email]

Job Objective To obtain the Medical Claims Processor position within your company and provide excellent service.

Highlights of Qualifications:

Wide experience in data entry and medical claim processing
Profound knowledge of codes applicable in CPT, HCPC, Revenue and ICD-9 systems.
Deep knowledge of Red Book, ASC Groupings, DRGs, Health Maintenance Organization (HMO) and IPA claim payments adjudication.
Familiarity about rules and regulations at DMHC and CMS.
Proficient in submission and editing claims electronically and other on-line systems for claim processing and problem registration
Skilled at decision-making, effective communication, analytical and research oriented tasks.
Ability to process claims for surgery, radiology, lab and medicine for CMS 1500 and CMS 1450 claim forms
Ability to comprehend DFRs and related benefits

Professional Experience:

Medical Claims Processor

Southwest Service Administrators Inc., Atlanta, GA

August 2007 – Present

Engaged to input data into processing system after interpreting medical coding and knowing terminology used in medicine professions in respect to procedures and diagnoses.
Ensured to process assigned claim forms and inspect apt allocation of co-pays, deductibles, reimbursements and co-insurance.
Complied with all judgmental policies and processes to assure appropriate claim payments.
Provided excellent customer service to all providers, members, insurance companies and billing department.
Maintained written record of phone calls in system and adhered with issues as required.
Solved all issues related to claim adjudication and customer complaints and queries as received over telephone.
Researched and analyzed claim overpayments and funds requirements.

Medical Claims Processor

Benefits Administration Corp., Inc., Atlanta, GA

May 2004 – July 2007

Ensured to take minimum assistance for processing complex claims.
Researched and processed different sets of medical plans as well as benefits.
Replied to inquires received in written format from participants and providers in relation to medical benefits.
Entered medical claim related information into PCM application.
Evaluated claim database which had been rejected earlier.
Calculated apposite amount to be paid to recipient and processed crucial payment transactions accordingly.
Performed and managed routine follow up activities.

Education

Bachelor’s Degree in Health Care Management

Woodbury Institute of Champlain College, Montpelier, VT