Adam Rodriguez Douglas
Kingston
Summary
Achieved efficient processing of medical claims billing and strengthened client and provider service interactions. Contributed to a dynamic work environment that promoted analytical thinking and professional growth. Sought full-time roles that provided opportunities for skill enhancement and career advancement.
Overview
22
22
years of professional experience
Work History
Senior Claims Examiner-Remote
TMG Health/Cognizant
Jessup, Pennsylvania
05.2015 - Current
- Review and process medical claims for payment or refund.
- Research claims for any regulations per Medicare and Medicaid guidelines.
- Manually price claims based on contracted agreements and multiple procedure reductions.
- Research and resolve service requests sent in by members or clients.
- Maintain a required monthly quality score and weekly production quota.
Health Insurance Biller
National MedTrans
Ronkonkoma, New York
05.2013 - 04.2015
- Communicated with contracted providers and various health insurance companies.
- Communicated with members about health insurance coverages.
- Reviewed and processed claims for reimbursement.
- Created EOPs/checks for bi weekly claims.
- Maintained a portfolio of contracted provider accounts.
Mortgage Prequalification Representative
Genpact
Wilkes Barre, Pennsylvania
03.2010 - 04.2013
- Answered incoming calls on an auto dialer.
- Input customer information into a Salesforce application.
- Answered customer inquiries regarding finance/refinance options.
- Made outbound calls to potential customers who expressed interest through the client website.
- Reviewed eligibility for government backed programs.
Home Health Aide
Bayada Home Health Care
Pittston, Pennsylvania
03.2004 - 03.2010
- Provided various levels of care in client’s homes and school settings.
- Maintained a daily log of client’s health and behavior.
- Interfaced with therapist and implemented all necessary care plans that were required for the client’s needs.
- Colibrated with parents and teachers regarding the client's progress and daily activities.
- Transported and assisted clients to and from medical appointments.
Education
Diploma - undefined
Waverly High School
Waverly, New York06.2003
Skills
- Configured and maintained AS400 environments, enhancing system functionality and user accessibility
- Achieved streamlined sales processes through effective use of Salesforce Enhanced customer interactions by implementing tailored Salesforce solutions Drove user adoption of Salesforce features, resulting in improved team productivity
- Delivered impactful statements to reinforce brand identity and values
- Analyzed market trends to formulate effective web strategies that drive traffic and improve brand visibility
- Achieved streamlined data analysis through proficient use of Microsoft Excel Enhanced documentation quality with expert Microsoft Word utilization Elevated presentation impact using Microsoft PowerPoint for compelling storytelling
- Articulated complex ideas clearly through proficient written and verbal communication
Accomplishments
I have excelled in expanding my knowledge of Medicare and Medicaid procedures and regulations. Always staying educated and informed on the ever evolving dynamics of procedures for billing, processing and remittances for the vast varied claim types. In recent years I have made it a priority to seize every opportunity to expand my knowledge on the growing demand for artificial intelligence and automation of healthcare bill and claims processing.
Timeline
Senior Claims Examiner-Remote
TMG Health/Cognizant
05.2015 - Current
Health Insurance Biller
National MedTrans
05.2013 - 04.2015
Mortgage Prequalification Representative
Genpact
03.2010 - 04.2013
Home Health Aide
Bayada Home Health Care
03.2004 - 03.2010
Diploma - undefined
Waverly High School