Jakaia Ringer

• Reviewed, verified, and processed healthcare and insurance claims with a focus on accuracy and compliance with policy guidelines.
• Entered detailed claims data into electronic health record (EHR) and claims management systems, ensuring 100% documentation accuracy.
• Adjudicated claims by applying medical codes (ICD, CPT, HCPCS) and calculating patient responsibility, deductibles, and co-pays.
• Communicated effectively with providers, patients, and payers to clarify claim discrepancies, resolve denials, and expedite approvals.
• Investigated and resolved billing errors, discrepancies, and potential fraud while adhering to HIPAA and organizational regulations.
• Maintained high-volume claims processing efficiency while meeting or exceeding departmental accuracy benchmarks.
• Generated detailed reports on claims trends, denials, and workflow metrics to support process improvement initiatives.

•Performed detailed insurance eligibility and benefits verification for medical services across commercial and government plans.

•Reviewed and identified prior authorization requirements, medical necessity guidelines, and coverage limitations.

•Coordinated with payers and providers to confirm policy information, documentation requirements, and authorization timeframes.

•Calculated accurate patient responsibility (deductibles, copays, coinsurance) to support clean billing and reduce claim rework.

•Ensured accurate benefit documentation to prevent claim delays and denials.

•Met and exceeded accuracy, productivity, and compliance metrics in a high-volume environment.

• Assisted patients and providers with claim status inquiries, billing inquiries, benefits verification, and laboratory coverage requirements.

• Conducted research and resolved discrepancies in patient accounts and insurance claims to facilitate timely and accurate adjudication.

• Communicated with multiple insurance carriers to investigate and expedite claim resolution.

• Educated patients on coverage details, authorization requirements, and financial responsibility.

• Documented all case activity in accordance with HIPAA and compliance guidelines.

• Consistently exceeded department performance metrics for quality, accuracy, and customer satisfaction.

• Processed and adjudicated high-volume medical claims with accuracy and adherence to payer guidelines.

• Investigated claim denials and rejections, identifying root causes and submitting corrections or appeals when necessary.

• Completed eligibility and coverage verification to ensure accurate claims submission and reduce denials.

• Maintained detailed documentation in claims systems while meeting productivity and quality expectations.

• Collaborated with internal teams and providers to resolve complex billing and claims issues.

• Recognized for strong accuracy, detail orientation, and consistency in meeting performance goals.