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Click here or scroll down to respond to this candidate2273 S Calle Maria JuanaCasa Grande AZ Street Address
PROFESSIONAL SUMMARYDedicated Quality Assurance Specialist with 7+ years of experience in medical billing, customer service, and quality control. Proven expertise in ensuring compliance with industry standards and regulations, optimizing operational efficiency, and enhancing customer satisfaction. Seeking a quality-focused position where I can leverage my skills in process improvement, audit management, and cross-functional team leadership to drive organizational excellence.CORE COMPETENCIES Quality Assurance & Control: Proficient in auditing claims, refining health plan procedures, and ensuring compliance with industry standards (Six Sigma-trained). Medical Billing & Coding: Expertise in ICD-9, ICD-10, medical terminology, patient records management, and claims processing. Process Improvement: Skilled in identifying process inefficiencies, implementing corrective actions, and conducting training to enhance team performance. Regulatory Compliance: Knowledgeable in food and safety regulations, insurance plan access, and eligibility file management. Technical Proficiency: Advanced skills in data entry, Microsoft Office Suite, PC operations, and medical billing software. Customer Service Excellence: Strong communication skills, adept at handling customer inquiries, resolving issues, and ensuring high levels of satisfaction.PROFESSIONAL EXPERIENCELucid Motors Casa Grande, AZQuality Inspector2021 PresentConducted comprehensive inspections and testing of battery modules and enclosures, ensuring compliance with company quality standards and safety regulations.Identified and reported defects and inconsistencies, contributing to a 30% reduction in product failures.Collaborated with engineering teams to improve testing protocols and inspection processes, enhancing overall product quality.Maintained detailed records of inspection results and provided feedback for continuous improvement initiatives.The Pit Beef San Tan Valley, AZOwner/Manager2017 2020 Spearheaded daily operations, ensuring strict adherence to food safety regulations and quality standards. Developed and implemented inventory management systems that reduced waste by 15%. Trained and supervised a team of 10+ staff, improving service efficiency and customer satisfaction ratings by 20%. Conducted regular quality audits to ensure consistent food preparation and service standards.Ameritox BOE Phoenix, AZBilling Order Entry Specialist2011 2018 Processed and verified medical claims, ensuring accuracy in diagnostic codes and payer ID information. Led cross-training initiatives on Accounts Receivable and Medical Billing, improving departmental flexibility. Researched and resolved billing discrepancies, reducing claim rejections by 30%.McKesson Phoenix, AZCall Service Representative I2008 2009 Managed patient registration and eligibility verification, ensuring compliance with medication assistance programs. Liaised with healthcare providers to update patient records, enhancing data accuracy and service delivery. Achieved a 95% satisfaction rate in patient interactions through effective communication and problem-solving.CVS/Caremark Scottsdale, AZQuality Control Analyst I2005 2008 Audited individual claims to ensure compliance with health plan procedures, maintaining a 98% accuracy rate. Conducted training sessions on claims processing, improving team productivity by 25%. Led Six Sigma projects aimed at streamlining claim processing workflows, resulting in a 20% reduction in processing time. Provided expert support in converting foreign prescription claims to U.S. equivalents, ensuring compliance with U.S. regulations. |
