OBJECTIVE:

Bi - Lingual Spanish/English Medical Biller/Health Claims Examiner seeking a position where I can combine knowledge gained through education and work experience, as well as learn, grow, and gain additional knowledge & experience.

SUMMARY

• Acknowledged for capacity to apply common sense understanding to carry out instruction furnished in written, oral, multitask independently, and coordinate demanding administrative operations.
• Proven ability to manage projects through planning, implementation and completion.
• Ability to deal with problems involving several concrete variables in standardized form.
• Motivated by challenges to overcome obstacles with solutions that are sound and financially feasible.
• Adherence to strict clinical protocols for confidentiality and communications.

TECHNICAL SKILLS

• HCFA Common Procedure Coding Systems (HCPCS)
• UB-04 and CMS-1500 Billing Forms
• Calculate Usual, Customary and Reasonable (UCR) fees
• Calculate Coordination of Benefits (COB)
• Physicians current Procedural Terminology (CPT)
• International Classification of Diseases (ICD.9CM)
• Medical/Dental Terminology
• Working knowledge of Medi soft Billing Systems, and Microsoft Word application’
• Experience in handling confidential paperwork/HIPAA complaints
• Type 85wpm, 10- key 14000KPH
• Extensive customer service experience
• Physician Worker’s compensation Pharmaceutical Billing

Experience:

Confidential

Data Analyst I

• Enrollment and premium related analysis for the organization. Ensure accurate and timely reconciliation of premiums for month-end reporting to management and corporate accounting for journal entries.
• Report observations to manager, pointing out areas of concern inaccuracy and efficiencies.
• Collaborate with the Enrollment team to correct deficiencies identified within the core system related to member’s enrollment. Interact directly with the State/Federal agencies when applicable. Provide Month-End reviews of all premiums, variances, expected analytics.
• Familiar with QNXT, PRA, SQL, and State Benefit sites.
• Familiar with Claims Viewer, Workflow, and Web.strat. Excessive Excel training.

Confidential

Pharmaceutical Litigation specialist

• Court litigation on cases that have Compromise & released.
• Creating Liens on EAMS, creating declaration of readiness to proceed documents, creating hearing documents, preparing paperwork for hearing representatives, legal mail correspondence, rebilling collection files to insurance companies, deal with denials and resubmissions, fee schedule management, remittance spreadsheets, update collections spreadsheets, processed liens through compdata update hearing information on cases, speak to attorneys about status on claims, create spreadsheets on reports not provided by doctors and system update reports

Confidential, Brea

Senior Svc Specialist

• Assisting customers with account information, Set up new accounts for existing customers, Extensions, payments, research and additional Loan information, Home Equity accounts, car loans, checking accounts, credit card accounts. Set up fixed rates on home equities, transfer funds from credit cards, home equities and checking accounts, assisting in car loan applications, Credit validations

Confidential

Customer Service Representative

• Assisting customers with purchases, Set up credit card applications, helped set up front store displays, cashier, filler, stocking new product on shelves, ran morning drills, store maintenance, scheduling.