SUMMARY:

• I am an ideal candidate for the position advertised, in that I have ten plus years in office administration/clerical work as well as thirteen years of excellent Call Center and Customer Service experience, and 10 years in in Confidential t and out Confidential t billing.
• I have a high degree of initiative, independence and originality in performing assigned tasks. I have utilized my various skills in proofreading documents for accuracy, proper use of grammar and spelling in finalizing for approval. I am knowledgeable in Preparing and formatting written correspondence to applicants, notifying them of their denial of their application, maintaining files, tracking systems, and entering data in logs. I have skills in maintaining pending files that require further action or further information and prepares statistical reports for management. I have the and skills in utilizing a variety of materials and resources which provide information on the Managed Health
• Care’s licensed health plans, federal/state health care programs, and consumer based organizations, local, state, and federal entities that serve consumers. I have several years in processing correspondence and mail as well as distributing to the appropriate staff. I am experienced in managing and scheduling meetings, reserving rooms and meeting places, scheduling dates, answering, screening, and directing incoming and outgoing calls to the appropriate staff. I am knowledgeable in several types of computer systems such as but not limited to like: Microsoft Word, Power Point, Excel,
• Access Database, Microsoft Outlook, Epic billing, IDX, Medi - cal, Blue Cross, Health Net Websites, and Health Connect systems as well as other various systems. I have experience in coding and batching, verifying insurance eligibility, posting EOB's, processing referrals, generating denial and eligibility letters, scheduling appointments, maintaining schedules, and providing data entry
• 10 key, editing reports and/or amending data, utilizing policies and procedures providing customer support to clients and Medical Directors. I am a team player who is punctual, dependable, flexible, resourceful, detail-oriented, and independent who has the ability to learn quickly. I am an enthusiastic and conscientious employee with integrity, who would be a valuable asset to your office.
• Detail oriented & trained in medical administrative support. Solid foundation in software applications, database management, and data entry; ability to master new technology and maintained strict Confidential t confidentiality. Medical Terminology & Transcription, Billing, Insurance Collection/verification, Coding and batching, Knowledge of Epic Billing System, ROI (Release of Information), 10 key, Alpha/Numeric Data Entry, Type (45 WPM), Accounting, Computer skills (WordPerfect, Microsoft word, Excel, Health Connect, Lotus Notes).

PROFESSIONAL EXPERIENCE:

Confidential, Sacramento.CA

Utilization Management Care Coordinator

Responsibilities:

• Coordinates activities related to in Confidential t utilization management (UM). Compiles daily in Confidential t log; reviews specified UM reports; QM coordination of grievances/activities/QOC, and CCS related activities. Responsible for inputting all in Confidential t and out Confidential t diagnosis codes into the system from the incoming hospital face sheets that come in through the fax. Responsible for collecting, posting and managing account payments. Submit claims and follow up with insurance companies.
• Acts as liaison to the providers’ offices and the UM/QM staff. Provides clerical assistance and prepares reports for the UM/QM Supervisor, Manager and/or Director of Medical Management. Receives and processes all incoming referrals within established turnaround times and production standards to include all necessary guidelines and information to complete. Adheres to company policies, procedures, attach the appropriate guidelines and directives to each account.
• Recognizes and enforces company security measures and complies with HIPAA standards. Process basic billing transactions, post EOB’s to accounts, process refunds to member’s accounts, Verifies member eligibility by systems inquiry or health plan contact. Generates denial eligibility letters. Answers telephone in a prompt, professional, courteous and helpful manner; screens and directs calls to appropriate staff member/department. Responds to routine requests and completes customer service tickets daily while maintaining an accurate phone call log.

Confidential, Sacramento.CA

Care Coordination Representative

Responsibilities:

• Analyzing and interpreting medical guidelines, Identify utilization reviews with missing information or needing correction, Transmits completed and error-free utilization reviews
• Responds to payer requests, provide support for a variety of issues related to payer communication. Used applications such as: Midas, Epic, MS4, DI, Shipper, IDX, Ecin, Right fax, and other computer programs.

Confidential, Sacramento.CA

Medical Billing Specialist

Responsibilities:

• Responsible for collecting, posting and managing account payments, submitting claims and following up with insurance companies. Prepared and submitted clean claims to various insurance companies. Resolved Confidential t billing complaints.
• Reviewed accounts for possible assignment and makes recommendations to the Billing Supervisor. Post EOB (explanation of benefits) accounts to Confidential ts accounts daily. Maintain the compliance of the department clinical practices and local, state and federal regulations.

Confidential, Rancho Cordova, CA

Medical Biller IV

Responsibilities:

• Maintain and release all ship-verified claims from bill review within three days. Develop a tickler file and hold all claims pending authorization and or documentation. Analyze and verify all dates of service and billed amounts. Send out all claims with corresponding documentation within seven days of releasing.
• Verifies all client data for completeness and accuracy prior to billing cycle. Assumes additional billing responsibilities as workloads dictate to meet departmental goals. Performs other related duties as directed by supervisor.

Confidential, Sacramento, CA

Chart Reader/Biller

Responsibilities:

• Examined charts for services requiring billing, itemized and priced services, computed bills, skilled in statistical and financial records concerning billing, accounts receivable, assigned Confidential t populations, answered inbound/outbound calls, insurance verifications, and provided excellence in customer service.

Confidential

Business Office Float Clerk

Responsibilities:

• Answered multiple phone lines in a call center environment, processed disability claims and other forms, submitted forms to EDD and other departments, processed refunds, distributed mail, Pre-voids and PIMS for Sacramento and Davis facilities, processed business office window coverage at Kaiser Morse, and processed co-payments information.
• Distributed and collected disability forms, authorized HIPAA forms, handled cash in Arbis & REGP Systems, faxed and answered heavy multiple phone lines and always provided excellence in customer service.

Confidential, Sacramento, CA

Hospitalist Services Coordinator

Responsibilities:

• Coding and batching, ensured billing sheets were received, scheduled appointments, prepared encounter forms, ensured accuracy of codes and other vital information, received rejection reports and documentation, maintained clinician’s schedules, and provided customer service support.

Confidential

Service Representative

Responsibilities:

• Responsible for all Confidential t diagnosis codes, calculated co-payments (batching and coding), filed charts, answered multi-lined telephone system and made appointments for Confidential ts in a personable and professional manner. Scheduling, registration (IDX system), ran daily reports.