Claims Customer service Representative – Potrero Grande Dr Monterey Park
Bell Gardens, CA
My objective is to obtain a position within the medical field that is meaningful and challenging; which can also contributes to my daily knowledge and growth as a medical professional. Also, to obtain a challenging position that will utilize my skills and experiences and which will also provide me with the opportunity for professional growth and advancement.
Authorized to work in the US for any employer
May 2017 to Present
Manage patients account. Contact payor. Follow up on claims status, claim denial. Appeal claim decision. Check eligibility.
November 2016 to Present
• Responding to telephone and written inquiries related to status of claims
• Research for status of provider claims and documents findings in the computerized tracking system
• Data entry and maintenance of provider inquiries including findings in computerized tracking system/ log
• Maintaining a working knowledge of Care1st Division of Financial Responsibility Matrix
• Checking Fee Schedule
• Calling out to Providers to inquire Member bill information such as: Outstanding balance, or if claim has been submitted.
• Providing accurate and timely feedback to management.
November 2014 to November 2016
• Enter complete and accurate Documentation in the MHC System
• Explain Benefits and coverage to members and providers
• Complete all follow up on members and provider issues in a timely manner
• Follow up on member grievances and complaints
• Follow up on pending authorization for specialist visits or medication, and assist member with authorization modification and extension request.
• Assist member with provider and IPA/Medical group change.
• Verify member’s eligibility through state and internal system and reinstate member into plan.
• Assist with Welcome and HEDIS outbound Calls to members
April 2012 to December 2013
• Obtained prior authorization for customer supplies.
• Maintained inventory of office supplies and equipment
• Document patients files with information such as supplies bought, or obtained
• Appeal any Medicare/Insurance claim that got denied
• Set up delivery and pick up schedules for supplies being shipped to customer
• Checked patient eligibility and claim status
• Called and obtained information for customer and clients file through doctor’s office, insurance companies, and/or other sources
• Extensive knowledge about medical data audits
• Meet with doctor offices to demonstrate supplies and provide information on how patients may qualify.
January 2013 to October 2013
• Assisted customers with questions in regards to products
• Review customer / Patient information for inaccuracies
• Obtain prior authorization
• Checked/ Reviewed customer insurance and same and similar
• Completing delivery tickets
• Request and review medical records
• Attend Health fairs to demonstrate Medical supplies such as: Wheelchairs, Commodes, Walker, Cane, Reclining couch, Hospital bed ect.
Certification in Medical Billing
January 2011 to June 2011
September 2009 to March 2010
High School Diploma
Medical Billing and Coding
• Fluent in Spanish
• Familiar with computer programs such as: MS Word/ Excel/ PowerPoint/ Outlook
• Typing speed is 45WPM
• Knowledge of ICD9 / ICD10 codes and HCPCS
• Knowledge of Revenue codes, Modifiers, Bill types
• Familiar with Medical Terminology
• Knowledge of Medi-Cal and Medicare claims submissions and processing Guidelines
• Familiar with HIPAA rules and regulations
• Skilled in the fitting of therapeutic shoes
• Proficient in data entry
• Excellence in Communication and organization skills