Tierra Howard
St Louis
Summary
Professional with comprehensive experience in claims processing and evaluation. Demonstrates strong analytical skills, thorough knowledge of insurance policies, and consistent track record of identifying and resolving complex claims. Valued team player with strong focus on collaboration and results, adaptable to evolving work environments. Known for reliability, problem-solving abilities, and effective communication with stakeholders.
Overview
9
9
years of professional experience
Work History
Claims Examiner
IBEW Local 1
St Louis, MO
04.2024 - Current
- Evaluated claims for accuracy and compliance with policies and regulations.
- Processed and adjudicated member claims efficiently, ensuring timely resolutions.
- Conducted thorough investigations to substantiate claim validity and prevent fraud.
- Collaborated with internal teams to streamline claims processing workflows.
- Implemented process improvements that increased overall claims handling efficiency.
- Analyzed trends in claim submissions to identify areas for operational enhancement.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Conducted thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
- Served as a mentor to junior examiners, sharing expertise and providing guidance on best practices within the field of claims examination.
- Identified opportunities for subrogation recovery through careful analysis of third-party liability cases, facilitating successful recoveries from at-fault parties or their insurers.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Process 150-300 claims per day
Payment Poster/Front Desk
Surgery Specialists
07.2023 - 04.2024
- Currently working with Surgery Specialists temporarily to assist them with Payment Posting
- Process refunds to insurance companies and patients
- Scanning and uploading data to patient charts
- Scheduling
- Processed payment transactions with high accuracy and efficiency.
- Contributed to the reduction of aged accounts receivable by prioritizing oldest outstanding balances for follow-up action.
- Accurately posted payments and adjustments both electronically and manually.
- Served as a key liaison between billing and collections departments, facilitating timely communication around patient account issues.
Payment Poster
National Medical Billing Services
Chesterfield, MO
12.2022 - 07.2023
- Post all personal, insurance and liability payments from Remittance and EOBs to appropriate accounts with minimum errors
- Analyze EOB information, including co-pays, deductible, co-insurance, contractual adjustments, denials and more to very accuracy of patient balances
- Add appropriate ANSI denial codes and comments to assure all necessary appeals and post payment follow up can take place
- Assist in performing comparison of downloaded files to the Direct Deposit and correct any discrepancies
- Assist in running and balancing credit cards daily
- Send all batch reconciliation information to the Finance department
- Assist in performing check deposits and assembling logs daily
- Contact patients, insurance, or third-party administrators when clarification of information is needed to successfully post payment
Claims Administrator
St. Louis County
Ferguson, MO
09.2021 - 10.2022
- Accurately post revenue transactions including charge, payment, adjustment, denial, and refund transactions to the billing system
- Contact payors to resolve problems associated with payment transactions.
- Perform electronic and paper billing
- Research and prepare refunds in accordance with established policies and procedures.
- Contact providers to obtain necessary information to file insurance claims and appeals Filing
- Make accurate and timely notes in the patient record
- Clarify health insurance coverage for coordination of benefits to process claims
- Scanning, and uploading documentation into the Electronic Health Record as needed
Claims Analyst III
Centene Corporation
Ferguson, MO
10.2017 - 07.2020
- Enter claim data accurately and timely in alignment with departmental production and quality goals
- Process claims payments within timeframes reflected in contractual agreements
- Verify claim payments are not duplicated
- Correctly adjudicate claims for contracted and non-contracted providers
- Pre-screen all claims for appropriated coding and documentation including but not limited to CPT, HCPCS, ICD-9 and ICD-10, DRG, Revenue Code, COB, Third Party Liability, and POS
- Proficient in Amisys, EPIC, CRM, AWD and Cenpas
Education
Bachelor of Science - Health Studies
Walden University
Minneapolis, MN05-2028
Skills
- ICD-10
- Revenue cycle management
- Medical records
- Claims processing
- Data verification
- Disability claims process
- Microsoft Office Suite
- Policy interpretation
- Healthcare procedures
- Coding systems
- Disability processing
- Payment processing
- Customer service and support
- MS office
- Healthcare common procedures coding system (HCPCS)
- Litigation support
- Coaching and mentoring
- Claims adjustment
- Claim form analysis
- Complex mathematics
Timeline
Claims Examiner
IBEW Local 1
04.2024 - Current
Payment Poster/Front Desk
Surgery Specialists
07.2023 - 04.2024
Payment Poster
National Medical Billing Services
12.2022 - 07.2023
Claims Administrator
St. Louis County
09.2021 - 10.2022
Claims Analyst III
Centene Corporation
10.2017 - 07.2020
Bachelor of Science - Health Studies
Walden University