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Candidate's Name  ROBLESEMAIL AVAILABLEPHONE NUMBER AVAILABLESUMMARYDedicated employee known for punctuality, pursuing employment options where good customer service and positive attitude will make a difference. Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking opportunities to expand skills while facilitating company growth. Results-focused professional with strength in Medical terminology, claims and insurance enrollment. Proactive leader with strengths in communication and collaboration. Proficient in leveraging medical insurance and customer service knowledge to promote exceptional medical rapport with physicians, hospitals, home health agencies, and patients. Adept at managing concurrent objectives to promote efficiency and influence positive outcomes. Insurance Claims Adjustor/processor/verification specialist with talent for authorizations and pre certifications. Strong knowledge of insurance and medical terminology. Communicative and team-oriented with proficiency in Microsoft and Excel. Proven history of fostering durable medical orders to meet team, individual and management objectives. Flexible hard worker ready to learn and contribute to team success.SKILLS Customer service MS Office Team management Computer skills ICD 10 Coding HIPPA Compliant Collections Administrative Skills Clerical Skills clinical skills Insurance Verification Prior Authorizations Setup patients in contracts to pay out of pocket and co insurances Customer service call center Reliable and trustworthy Conflict resolution Data management Critical thinkingCheck in and check out patientsEXPERIENCEASK CONSULTING(CignaNovember 2023December 2023 (temp)Provider Contract RepCompiled potential contracts figures to have dental providers join Cigna network IBEXJune 2023 -October 2023TempAssisted Delta dental members with their benefits, related benefits and eligibility. Submitted appeals, grievances to overturn billing processes. Ranstad StaffingFebruary 2022-May 2023(Temp)Assisted members with their State benefits, submitted appeals Pre-Imaging SchedulerSan Antonio, TXARA (Austin Radiology Associates)October 2021-Jan 2022TEK WESSEN/ Mar 2021 to September 2021 Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients. Verified that patients had proper insurance coverage prior to procedures or appointment scheduling. Updated all patient and insurance data regularly and carefully inputted changes into company's computer system. Checked documentation for appropriate coding, catching errors and making revisions. Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information. My responsibilities were compile dental rates for dental providers to have them become Cigna in network providers. Also handled 60 inbound calls. Role with Cigna as a Provider Contract Rep was for 1 month Nov 2023-Dec 2023. This wa my last project. Instructed clients on amounts covered under benefits plans in easy-to-understand terminology. Examined claims, records and procedures to grant approval of coverage. Retained strong medical terminology understanding in effort to better comprehend procedures. Handled billing related activities focused on medical specialties. Signed payment approvals accepted claims. Performed verification of Medicare coverage. Identified important patient and demographic information. Assisted patients weekly by reviewing personal cases and insurance coverage information. Pulled patient files and forwarded to appropriate offices for processing. Created and maintained accurate and confidential patient files according to regulatory mandates. Answered 50-75 average daily phone calls to schedule appointments and address patient inquiries. Called patients to schedule medical, surgical, MRI, mammography appointments, consistently double-checking information and availability. Communicated with patients to gather intake data and verify chart information. Contacted other medical facilities to confirm medical histories and prevent inaccurate diagnoses.Insurance Claims Adjuster SAN, TXKCI., USA/ 2005 to Sep 2021 Adhered to company and insurance client's guidelines in claims processes, estimate writing and claim closures. Recommended settlement offers and negotiates payment arrangements. Obtained all necessary information to complete proper evaluation of injury claims. Reviewed data to verify validity of claims and determine case management actions. Drafted statement of loss to summarize damages, payments and underlying policy coverage. Complied with company and insurance client's guidelines in claims processes, estimate writing and closing of claims, resulting in [Result]. Analyzed first reports of loss and underlying file material to determine if claim was suspect. Contacted injured parties and legal representatives to negotiate final settlements for claims. Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control. Interviewed claimants, medical specialists and employers to determine pertinent claim information. Mentored 15 new members of claims staff in proper procedures. Conducted claim and estimate re-inspections. Managed caseload of 100 clients each quarter.Healthcare Support WorkerMaitland, FLHealthcare Support/ Jun 2020 to Jul 2020 Engaged customers and provided high level of service by carefully explaining details about documents. Maintained pleasant and cordial attitude, remaining calm when issues arose. Fulfilled requests for title documentation, letters of permission and insurance claims. Provided quick turnaround time when customers called with questions, usually within 24 hours. Received underwriting approvals after accurately completing applications for insurance coverage. Cultivated lasting professional relationships, which created continuous client referral streams within community. Reviewed coverage plans and strategic initiatives, determining how best to align new offerings with business goals. Exceeded team goals by partnering with staff to share and implement best practices. Reduced financial discrepancies by accurately resolving billing issues while processing applications and cancellations. Diligently filed and followed up on third party claims. EDUCATION AND TRAININGHigh School DiplomaSIDNEY LANIER HIGH SCHOOL Jun 1986San Antonio, TX