Jalanta Garner
Colorado Springs
Summary
Results-driven professional with over 6 years in medical claims processing and quality assurance. Demonstrates expertise in medical terminology, claims processing software, and verbal communication. Committed to enhancing operational efficiency and ensuring compliance with federal and state regulations.
Overview
2027
2027
years of professional experience
Work History
M & R Claims Processing Specialist
United Healthcare Military & Veterans
Colorado Springs, CO
2020 - Current
- Processed medical claims for military members and their families, determining policy coverage for services
- Ensured claims are in compliance with federal, state and company regulations and polices
- Adjudicated claims with precision and applying complex benefit plan documents, regulatory mandates and internal policies, utilizing the internal Medicare & Retirement COSMOS platform and Claims Processing Workstation
- Analyzed and resolved complex claims issues across multiple proprietary and third-party platforms, ensuring accurate pricing, authorizations, and benefit application
- Ensured data integrity and compliance for unreconciled claims by meticulously reviewing and integrating health plan benefit information and denial codes into the system
Quality Specialist
United Healthcare Military & Veterans
Colorado Springs, CO
2018 - 2020
- Conduct quality audits to ensure compliance with healthcare regulations and standards.
- Collaborate with cross-functional teams to identify process improvements and enhance service delivery.
- Identify overpayments and errors to ensure claims are processed to company and policy standards
- Analyze claims for data entry and accuracy
- Collaborated with cross-functional teams to identify process improvements, resulting in increased production efficiency and cost savings.
Reports and Controls First Pass Processor
United Healthcare Military & Veterans
Colorado Springs, CO
2014 - 2018
- Processed healthcare claims with high accuracy and attention to detail
- Managed data entry tasks to ensure timely and efficient claim handling
- Collaborated with team members to resolve discrepancies in claim submissions
- Assisted in training new processors on company protocols and software use
- Specialized dedicated training in researching and validating professional claims that the internal processing system (COSMOS) is unable to auto-adjudicate
- Analyzed system-denied claims to identify root caused of inaccuracies, proposing and implementing solutions for process or system configuration enhancements
Education
High School Diploma -
Mitchell High School
Colorado Springs, CO2001
Skills
- Proficient with the multiple platforms of Microsoft
- Claims processing software
- Verbal communication
- Data Analysis
- Medical terminology and coding
- Data entry proficiency
- Regulatory compliance
- Customer service
Timeline
M & R Claims Processing Specialist
United Healthcare Military & Veterans
2020 - Current
Quality Specialist
United Healthcare Military & Veterans
2018 - 2020
Reports and Controls First Pass Processor
United Healthcare Military & Veterans
2014 - 2018
High School Diploma -
Mitchell High School