JUSTICE LOYD
Intermountain Healthcare
Marietta
8
years of professional experience
Detail-oriented healthcare professional with experience in medical claims processing, billing research, provider inquiries, and health plan compliance. Currently serving as a Claims Examiner I at Intermountain Health, with a strong background in customer service, account management, and payment resolution. Skilled in analytical problem-solving, effective communication, and cross-departmental collaboration.
Work History
Claims Examiner I
1 Year- Review and adjudicate contracted professional medical claims, analyzing pending edits involving referrals, corrected claims, coordination of benefits (COB), hospice reviews, and coding requirements to determine appropriate processing actions.
- Evaluate system-generated claim edits for accuracy, applying established denial reasons or approving claims for continued processing in accordance with payer guidelines and internal procedures.
- Research and respond to provider and health plan inquiries through inbound phone calls and email correspondence, providing information regarding claim status, payment amounts, denial reasons, appeals, and billing-related concerns.
- Investigate reported payment discrepancies, initiate formal payment disputes, and collaborate with the Provider Dispute Resolution team to facilitate further review and resolution.
- Track assigned provider inquiries and payment disputes through completion, communicating investigation findings and resolutions directly to providers.
- Manage Health Plan Compliance inquiries by researching claim receipt dates, payment and denial information, processing outcomes, and provider participation status.
- Identify potential claim processing discrepancies, prepare detailed requests for supervisory audits, and follow up with health plans to communicate completed investigation findings.
- Coordinate medical records reviews by matching provider-submitted documentation to corresponding claims and dates of service, routing records to medical screeners, and returning completed determinations to requesting claims examiners.
Claims Processing Specialist
9 Months- Verified Medicare member eligibility, reviewed benefit plan information, and confirmed available benefit allowances to support accurate medical supply order processing.
- Reviewed medical supply selections against applicable product codes and benefit limits to identify discrepancies and ensure order accuracy.
- Handled inbound member calls regarding benefits, billing inquiries, account balances, and order-related concerns, providing clear and accurate information.
- Explained out-of-pocket financial responsibilities, discussed options for adjusting orders to remain within benefit limits, and processed payments for balances exceeding available coverage.
- Researched and resolved order processing issues, maintained accurate account documentation, and supported timely completion of member requests.
Customer Service Representative
1 Year 4 Months- Managed inbound customer inquiries regarding account balances, billing histories, payment processing, and service-related concerns.
- Reviewed customer account information, explained billing charges, and processed payments while maintaining accurate account records.
- Coordinated service appointments and collaborated with appropriate departments to address scheduling issues, customer complaints, and escalated concerns.
- Researched customer inquiries, identified appropriate resolutions, and maintained professional communication to support customer satisfaction and account servicing.
Account Representative
9 Months- Managed day-to-day activities for assigned customer accounts under the guidance of an established freight broker, maintaining professional relationships and ensuring transportation needs were addressed.
- Served as a point of contact for customers and carriers, providing shipment updates, responding to inquiries, and maintaining consistent communication throughout the transportation process.
- Negotiated carrier rates, reviewed transportation costs, and prepared rate confirmation documents to support accurate pricing and shipment coordination.
- Proactively monitored active shipments, identified potential service disruptions, and collaborated with customers and carriers to develop timely solutions.
- Addressed escalated customer concerns, coordinated shipment adjustments, and maintained client relationships through effective communication and problem-solving.
- Coordinated completed shipments with the billing department to support accurate customer invoicing and timely carrier payments.
Lien Specialist
2 Years- Handled inbound customer inquiries regarding delinquent accounts, outstanding balances, lien notices, and collections-related concerns, providing clear and professional account assistance.
- Researched and analyzed customer billing histories to identify past-due balances, delinquency timelines, additional fees, and reasons for lien placement.
- Communicated complex financial information to customers, explaining account charges, payment obligations, lien procedures, and available resolution options.
- Assisted customers with resolving delinquent balances by discussing payment arrangements, payment-in-full options, and strategies to prevent additional liens or fees.
- Managed escalated billing concerns with professionalism and empathy, maintaining positive customer relationships while addressing sensitive financial situations.
- Supported monthly lien processing by verifying property ownership and mailing addresses through Clark County public records to ensure accurate lien notifications.
Dispatch Supervisor
1 Year 9 Months- Supervised daily dispatch operations, coordinating emergency and non-emergency service requests while ensuring timely communication between customers, dispatch personnel, and field teams.
- Provided leadership, training, and ongoing support to dispatch team members, promoting operational accuracy, effective communication, and adherence to established procedures.
- Managed escalated service concerns, assessed time-sensitive situations, and coordinated appropriate resolutions while maintaining professionalism and customer satisfaction.
- Monitored operational activities, maintained accurate service documentation, and collaborated with team members to improve workflow efficiency and service delivery.
Education
Certificate - Medical Billing & Coding
- Completed 9 of 12 required credits; program currently paused
High School Diploma
Skills
Effective Communication
Customer Service & Relationship Management
Medical Claims Processing & Adjudication
Billing Research & Payment Resolution
Analytical Thinking & Problem-Solving
Cross-Departmental Collaboration
Microsoft Office Suite (Excel
Outlook & Word)
Regulatory Compliance & Documentation
Timeline
Claims Examiner I
Intermountain Healthcare
10.2025 - CurrentRead More
Claims Processing Specialist
Five Star Call Centers
01.2025 - 10.2025Read More
Customer Service Representative
Intouch CX
08.2023 - 12.2024Read More
Account Representative
Total Quality Logistics
09.2022 - 06.2023Read More
Lien Specialist
Republic Services
09.2020 - 09.2022Read More
Dispatch Supervisor
Security Partners
12.2018 - 09.2020Read More
Mira Monte High School
High School Diploma
Read More
University of Phoenix
Certificate from Medical Billing & Coding
Read More