23678
Julia Taylor, CPC
PROFESSIONAL AFFILIATIONS and CERTIFICATIONS
American Academy of Professional Coders (AAPC), Member in good standing
Certified Professional Coder, CPC
Preparing to sit for the exam to become a Certified Risk Adjustment Coder, CRC
EDUCATION
Western Governors University
Enrolled Summer of 2020, Bachelor of Science, Health Information Management program
RELEVANT SKILLS
CPT ICD-10-CM HCPCS
Medical Terminology Anatomy Physiology
HIPAA Policies Coding Guidelines Modifiers
NCCI Edits Claims Analysis Call Center
Claims Examination Quality Assurance CMS-1500 Claims
UB-04 Claims PowerMHS Governmental Insurance
Commercial Insurance Facets
PROFESSIONAL EXPERIENCE
Member Benefits Analyst, Medasource/CareSource, December 2018-Present, Remote Position
Audit data according to payor contract terms, National and Local Coverage Determinations (NCD and LCD), state
administrative codes, and regulatory guidelines
Maintained accurate data through updates to Facets medical benefit configuration according to audit findings
Verify benefit grid information to reduce claim expenditures, resolving discrepancies as necessary, alerting clients and
initiating configuration updates
Analyze configuration gaps, tracking issues and updating claims processing software accordingly
Create code sets to support medical & reimbursement policies, and review existing medical policies annually to
ensure compliance and accuracy
Quality Auditor, Blue Cross Blue Shield of North Carolina, 2014-2018, Remote Position
Audited processed high-dollar claims of $5,000 to $1 million, to confirm correct and compliant processing according
to insurance and internal guidelines
Reviewed policies and procedures to identify errors and track and document all issues for management review,
recommending opportunities for review
Senior Level Claims Examiner, Dell, United Healthcare, 2013-2014, Remote Position
Processed complex claims to ensure compliant and accurate data exchange
Researched Medicaid claim adjustments and coordination of benefit discrepancies according to contract updates
Claims Examiner, Blue Cross Blue Shield of North Carolina, 2008-2012, Remote Position
Processed CMS-1500 and UC-04 claims, accounting for patient deductibles, co-payments, co-insurance and out-ofpocket
maximums
Completed data entry to ensure accurate claims data in PowerMHS system
Reviewed processed claims to identify inconsistencies and errors
Provided optimal customer service to internal and external clients, resolving inquiries quickly and efficiently
Bookmark Resume
Please enable the bookmarks plugin to activate this feature.
Contact Candidate
To contact this candidate email julia_taylor3@hotmail.com