PO Box 505
Tieton WA 98947

CAREER SUMMARY - A CPC Apprentice with 9 months coding experience coupled with over 16 years in claims processing and customer service. Proficient with Microsoft Word and Excel. Excellent organizational and problem solving skills.


Personal Group Inc, Yakima, WA June 2010- March 2011

Health Information Technician II: Duties include entry of information from medical charts and forms into computer programs. Codes diseases, operations, diagnoses, and treatments based on ICD-9 CM, CPT, and HCPCS services, to the highest degree of specificity utilizing current coding guidelines.

Adaptis, Yakima, WA August 2005 May 2010

Claims Examiner III: Duties include resolving claim edits such as benefit accumulation, coordination of benefits, referrals/
prior authorization/notification review, and timely filing requirements. Able to process claims with little supervision. Consistently exceeds quality and quantity standards. Remains customer focused including internal/external customers.

Other Health Insurance Investigator (OHI): Responsible for reviewing and setting up coordination of benefits based on returned OHI letters, Explanation of Benefits, and telephone calls. Initiates calls to insurance carriers to establish coverage dates, plan members, group numbers, and payment information for Claims Examiners who process coordination of benefit edits.

Provider Service Representative: Answer incoming phone calls, locate and review related claims, membership, and provider information to ensure accurate interpretation of claims status, respond to all inquires in a highly professional manner, communicate information clearly, accurately and completely, assist in identifying and resolving provider billing issues, and operate effectively in a team oriented call center environment.

Delta Health Systems, Stockton, CA May 1997 to June 2005

Duties included data entry of claims such as medical and hospital. Reviewed and corrected claims based on benefit maximums, third party liability, other insurance information, and Medicare. Maintained over 96% overall accuracy rate and 100% payment, and financial accuracy rates. Processed all senior claims within HCFA guidelines and processed unaffiliated claims within 30 days and affiliated claims within 60 days from the earliest date received. Position required knowledge of medical and insurance terminology (CPT, ICD-9, HCFA 1500, and UB-92). Processed hospital claims according to contracts for various providers. Handled provider s correspondence such as check tracers and appeals. Handled a variety of different HMO plans and helped provide support for self-funded claims processing.


Completed numerous courses offered by America s Health Insurance Plans (AHIP) including Health Insurance Fundamentals, Fraud, Medical Expenses, Disability and Long-Term Care.