Bonnie Butler
glendale
Summary
Medical Claims Examiner with extensive experience in data analysis and claims processing at Banner Hospital. Proven track record in managing complex cases and achieving optimal turnaround times while ensuring compliance with healthcare regulations. Expertise in verifying healthcare billing accuracy, negotiating payment arrangements, and assessing claim settlements. Demonstrated ability to enhance claims processing efficiency, resulting in cost-effective outcomes for employers.
Overview
14
14
years of professional experience
Work History
Medical Claims Examiner
Banner Hospital
Mesa
11.2021 - Current
- Compiles data on claim forms to verify the accuracy of information prior to submission for payment processing.
- Collaborate with internal teams and external partners in order to resolve any issues related to claim processing or appeals.
- Managed a large caseload of complex medical claims while meeting turnaround times set by the company's standards.
- Interpreted various types of health insurance contracts in order to correctly adjudicate claims payments.
- Evaluates patient medical reports to determine necessary paperwork, and subsequent steps for claims.
- Confirm proper legal procedures by complying with federal, state, and company regulations.
- Approved or denied claims requests through collaboration with insurance agents and medical offices.
- Paid and processed claims within the designated authority level.
- Analyzes information gathered by investigation, and reports findings and recommendations.
- Verified and analyzed data used in settling claims to validate claims and settlements, according to company practices and procedures.
- Performed audits of submitted claims to validate accuracy of payment calculations.
- Maintained updated knowledge of changes in healthcare regulations impacting claims processing.
- Verified insurance coverage and eligibility of patients for services rendered.
- Collaborated with internal departments such as billing, customer service, and IT.
Medical Claims Analyst
The Jacobson Group
02.2020 - 08.2021
- Reviewed and processed medical claims for accuracy, ensuring compliance with insurance regulations.
- Maintained current knowledge of coding updates and healthcare reimbursement systems.
- Collaborated with departments to gather necessary information for claim resolution.
- Responded to inquiries and resolved specific claim issues promptly.
- Analyzed claims from initial submission through finalization, ensuring complete processing.
- Tracked claims payments accurately, identifying and correcting discrepancies as needed.
- Attended training sessions and workshops to stay updated on industry practices.
- Exercised discretion and confidentiality while handling sensitive claim information.
Payment Poster/Senior Claims Specialist
PSA Behavior Health Agency
Phoenix
10.2017 - 05.2018
- Research, reconciled and rebilled to make necessary adjustments to claims as needed, separated by funding categories all performed on Credible with regards to reconciliation.
- Corresponded with funding sources (state Medicaid, Cenpatico, Cigna, BCBS of AZ, United Behavioral Health, etc.) by email/phone/fax regularly on claim issues and make decisions as necessary regarding all agency claims.
- Overseen monthly client eligibility issues for the above-mentioned RHBA(s) as needed and worked closely with funding sources to resolve any billing issues.
- Assisted in creating and maintaining agency reports regarding any claim's issues.
- Back up for other claims specialists in the office.
- Recognized for the ability to efficiently process Behavioral and Medical claims for major and private insurance carriers including all lines of business.
- Assisted Claims Manager as needed with incoming data files for the agency's contracts, and any special projects.
Subject Matter Expert/Medical Claims Analyst II
Trizetto, a Cognizant company
Phoenix
01.2016 - 04.2017
- Maintained external customer relations by addressing claims issues and ensuring accurate information.
- Examined and entered complex claims for appropriateness of care per accepted coverage guidelines.
- Processed intricate claims across multiple plans, utilizing both automated systems and manual documentation.
- Approved, pending, or denied payments according to established coverage guidelines.
- Assisted in training new staff members and supporting management with workflow planning.
- Facilitated daily meetings with over 25 claims processors, enhancing team collaboration.
- Provided subject matter expertise during discussions with senior leadership on operational challenges.
- Mentored junior staff on product design best practices and implementation strategies.
Medicare Claims Analyst I
Health Choice of Arizona
Phoenix
05.2015 - 01.2016
- Entered claims data accurately and promptly to meet departmental production goals.
- Ensured timely payment of claims in accordance with contractual agreements.
- Adjudicated claims for both contracted and non-contracted providers.
- Pre-screened all claim types for proper coding and documentation, including CPT, HCPCS, and ICD-9.
- Reviewed coding compliance with CMS and Correct Coding guidelines for accurate billing.
- Identified and referred third-party liability or coordination of benefits issues to the COB/TBL Coordinator.
- Communicated trends to Claims Department Supervisor to inform provider training program development.
Quality Control Auditor
Trizetto, a Cognizant company
Phoenix
10.2011 - 04.2014
- Conducted routine audits for operational staff, including claims and customer service personnel.
- Developed and reported results of service level audits, providing error statements to management.
- Advised quality management leadership on training needs based on audit findings.
- Performed focus audits and created ad hoc reports summarizing results for stakeholders.
- Executed system testing to verify proper functioning of business processes.
- Collaborated with project teams as required to support operational initiatives.
- Coordinated with document writers to recommend revisions of Desk Level Procedures.
- Assisted Benefit Rule Configuration team with daily troubleshooting of system issues.
- Reviewed product specifications and identified areas where improvement is needed.
Education
Master of Business Administration (M.B.A.) - Health Care Management
The University of Arizona
Tucson, AZ, US05.2025
Health Care Business Administration -
Grand Canyon university
US01.2023
Skills
- Claims processing and analysis
- Team collaboration and leadership
- Project management skills
- Problem solving and resolution
- Attention to detail
- HIPAA compliance expertise
- Insurance policy knowledge
- Data entry proficiency
- Documentation review skills
- Medical terminology familiarity
- Electronic claims processing systems
- Insurance verification techniques
Claim Payment and Research Systems
Experience with processing and payment applications including Amysis, Credible, Facets version 4.71/5.0, Diamond, QNXT 3.2, Encoder Pro, Onyx, Employee Portal, NPI Registry, Macess, and Gateway EDI. Claim Payment Systems: Facets 5.0, Trailblazers, Burgess Reimbursement System, Multiplan Repricing, and CMS Pricers. Proficient in various systems and portals, including CMS, Microsoft Word, Excel, PowerPoint, Adobe Acrobat, AHCCCS, Cenpatico, Mercy Maricopa Integrated Center, United Health Care, and Health Choice.
References
References available upon request.
Timeline
Medical Claims Examiner
Banner Hospital
11.2021 - Current
Medical Claims Analyst
The Jacobson Group
02.2020 - 08.2021
Payment Poster/Senior Claims Specialist
PSA Behavior Health Agency
10.2017 - 05.2018
Subject Matter Expert/Medical Claims Analyst II
Trizetto, a Cognizant company
01.2016 - 04.2017
Medicare Claims Analyst I
Health Choice of Arizona
05.2015 - 01.2016
Quality Control Auditor
Trizetto, a Cognizant company
10.2011 - 04.2014
Master of Business Administration (M.B.A.) - Health Care Management
The University of Arizona
Health Care Business Administration -
Grand Canyon university