Timothy Adams

Seasoned Medical Auditor, Claims Examiner, Claims Processor, Claims Adjustor, Claims Credentialing Auditor, NASM CPT Trainer, and a CES and PES specialist, with more than 12 plus years of experience in the fast-paced industry. Also have experience in customer care and customer care advocacy. With knowledge in entry and mid level roles, such as administrative work, call center, and data and analysis.

Strong with math and numbers. Excellent computer and technology skills. Proven track record of achieving exceptional results in healthcare and the data analyst industry. Fast learner who loves being trained in new things that help broaden skill set and knowledge to achieve success in any company.

• Claims Examiner- Review submitted claims to verify that the diagnosis, treatments, and costs are reasonable and covered under the specific insurance policy. Analyze medical charts, bills, and doctor notes to establish proof of loss and confirm information integrity. Identify billing discrepancies, investigate questionable claims, and escalate suspicious activities to investigators. Coordinate with healthcare providers, patients, and insurance agents to gather missing information or resolve complex, disputed cases. Ensure all claim handling aligns with strict state/federal regulations and internal company guidelines. Work with Medicare and Medicaid claims.
• Claims Processor- Foundational understanding of medical codes (including ICD-10 and CPT) and healthcare procedures. Strong attention to detail for reviewing financial and medical data without making costly errors. The ability to accurately interpret complex health insurance contracts, riders, and benefit tiers. Evaluate incoming claims to ensure they are accurate, complete, and compliant with payer requirements. Ensure that CPT and ICD codes perfectly match the medical services provided. Process forms to properly allocate deductibles, co-pays, co-insurance, and determine exact provider or patient reimbursements. Identify discrepancies or missing documentation, flag errors, and help resolve denied or pending claims. Fast, accurate data entry into claims processing and revenue cycle systems. The ability to spot tiny discrepancies in billing codes or patient information. Capable of effectively corresponding with healthcare providers, insurance carriers, and patients.
• Claims Auditor- Quickly promoted to the Auditing Department at NTT Data after 5 years with the Processing Department. Worked with auditing claims for 9 years. Verify that diagnostic (ICD-10) and procedural (CPT/HCPCS) codes accurately reflect the clinical documentation. Ensure all billing strictly adheres to insurance policies, contracts, and CMS regulations. Flag duplicate billing, upcoding (billing for a more complex service than provided), and other suspicious patterns. Review rejected claims and recommend corrective actions to resolve discrepancies with insurance providers. Compile and document findings to share with management, healthcare providers, or Claims Examiners to improve processing workflows. Deep familiarity with medical terminology, explanation of benefits (EOBs), and electronic health record systems. Strong analytical, problem-solving, and detail-oriented skills to parse dense medical data. Investigate claims, check for errors or inconsistencies, and ensure payments adhere to legal standards and contract terms. Work with Medicare and Medicaid claims.
• Proficient in Microsoft Office (Word, Excel, PowerPoint, Outlook and Microsoft 365).

Claims Examiner at Blue Cross Blue Shield (2003-02 – 2012-10)

• Review submitted documentation against patient policy terms to ensure the charges are accurate, medically necessary, and comply with state and federal regulations. Strong attention to detail, analytical skills, and working knowledge of medical terminology and insurance guidelines. Studied specific member policy certificates to establish proof of loss and determine deductibles or out-of-pocket costs.
• Reviewing medical codes (CPT, ICD) and provider billing to authorize payment, deny coverage, or flag claims for further investigation.
• Working with doctors, hospitals, and medical facilities to clarify coding errors or resolve complex cases. This was a work at home position which ended in Oct 2012 due to a large company layoff and budget cuts.

Repair Specialist/Customer Care Representative/Customer Care Advocate at Jared's The Galleria of Jewelry (2012-12 – 2013-07)

• Bench jeweler-craftsman who worked in the on-site repair shop to restore, alter, and fix precious jewelry.
• Jewelry Repair: Performing ring resizing, re-tipping prongs, soldering broken chains, and repairing damaged clasps.
• Stone Setting: Inspecting, tightening, and setting loose or replacement gemstones and diamonds.
• Quality Assurance: Inspecting every item to ensure it meets strict quality standards before it leaves the workshop.

Worship Leader/Minister, Producer, Singer/Songwriter, Tech/Music Engineer at Various (Worship Ministry) (2008-07 – Present)

• Active Faith: Professed Christian faith, active church involvement, and a lifestyle aligned with biblical standards.
• Pastoral Heart: A passion for shepherding the congregation into meaningful spiritual experiences led through worship of music and song.
• Ability to select songs and write prayers that accurately reflect the church's doctrine and beliefs.
• Silverglass Music Studio- Worked with Cubase software, coordinated session schedules, hired technical and creative staff, marketed the studio to potential new clients, and oversaw day-to-day budgeting and billing.
• Operate the mixing consoles and recording software. Set up microphones, route cables, and ensure the audio is captured flawlessly without technical issues.
• Acted as an apprentice or extra pair of hands during sessions, helping with equipment breakdown, mic adjustments, and general technical support.
• Mixing & Mastering Engineer: Mixing engineer by combining individual recorded tracks (vocals, drums, guitars) into a single cohesive track. Put the final polish on the mixed project so it will sound consistent and radio-ready.
• Guide the creative vision of the project/record. Help with song arrangement, provide objective feedback, guide the performance, and bring out the best possible takes from the musicians.
• Pre-production: Preparing the studio, tuning instruments, placing microphones correctly, and testing software before the artist arrives.
• Tracking/Recording: Running the recording session, capturing takes, and managing digital audio workstations (DAWs).
• Maintenance: Troubleshooting faulty cables, cleaning the facility, updating equipment firmware, and maintaining acoustic environments.
• Eagerness to learn all music software when properly trained. Fast learner and can pick up any computer software rather quickly.
• 5 plus years as a Worship Leader (Crossroads Church, FL)
• 10 plus years in a touring Ministry band (True Witness)
• Toured in a ministry Christian band across the US. Lead worship in many different venues including on stages at Soulfest Music Festival in NH, Winterjam and Winterfest, as well as numerous churches in various locations across Eastern and Southern states in the US. True Witness band (youtube links). Opened for major Christian artists in various venues including festival outlets.
• Instrumental & Vocal Skills: Proficiency in a lead instrument (like acoustic guitar or piano) and strong vocal abilities.
• Theory & Repertoire: A solid understanding of basic music theory, the ability to read music/charts, and knowledge of diverse worship genres (hymns to contemporary Christian music).
• Technical Familiarity: An understanding of audio, sound mixing, and multimedia equipment.
• Team Management: Experience recruiting, mentoring, and scheduling volunteer musicians and vocalists.
• Service Planning: Collaborating with pastors to curate setlists that align with weekly sermon themes.
• Communication: Clear verbal and written skills to guide the band during rehearsals and engage the congregation during the service.

High School Diploma in Computer Programming – Bloomingdale High School (1993 – 1997)

Some College in Computer Programming/Science (Major), Music Theology and Music Worship (Minor) – Hillsborough Community College (1997-08 – 1999-08)