Summary

Highly organized and detail - oriented professional with the background in

Project Coordinating, Administration and calendar management. While working

with United Healthcare, processed/Purged medical records to Iron Mountain

and created spreadsheet for department records. Processed department

supplies expenses. Generated letters for itemized billing and logged new

claims in the system and database.

Education

Bachelors in Science Degree in Business Management, University of Phoenix,

Phoenix (Graduated)

Skills

Microsoft Word, Excel, Power Point, Outlook, Sharepoint, Webex, Attention

to Details.

Professional Experiences:

Employer: UnitedHealthcare (HMO/PPO/Medicare Plans), (FTE), Cypress, CA,

11/2002-03/2014

Senior Project Coordinator- Clinical Services

Provided support to the Project Managers on my team. Managed my Director's

schedules and calendars. Arranged travel plans and processed any expenses.

Scheduled, coordinated, facilitated committee meetings, and prepared

meeting packets for 4 different committee meetings. Recorded and completed

meeting minutes and filed signed minutes. Granted access to all committee

membership in the Sharepoint. Hosted meetings through Webex.

Processed department supplies expenses. Registered/Renewed users' online

subscriptions and ordered Medical Book subscriptions, a Business Segment

Liaison to our department and to others.

Formatted and updated Medical Policies for final publishing to different

websites (member & provider portals). Also internal Sharepoint and

external websites. Maintained department Sharepoints.

Information Specialist/Clinical Information Associate-Case Management

Assisted Case Managers in Transplant, Clinical Trials and General Case

Management. Collected, verified and input a variety of data on the

members' charts. Created Clinical Trials authorizations on the system.

Acted as a department resource in resolving escalated provider and customer

issues.

Answered incoming and made outgoing phone calls to the members, Hospitals

and Medical Groups. Provided customers with verification on eligibility

and interpretation of benefits. Generated approval, denial & delay of

decision letters.

Processed Health Management and Disease Management referrals, processed

claims and matched authorization on the system. Processed/Purged medical

records to Iron Mountain and created spreadsheet for department records.

Employer: PacifiCare, (FTE), Cypress, CA, 10/2000-10/2002

Claims Associate-Claims Provider Resolution Team (Pacificare bought by

United Healthcare)

Organized and separated claim inquiries coming from member services and

providers via mail and fax.

Verified eligibility, services and assigned provider information. Reviewed

claims to identify duplications.

Assigned the correct claim type codes, linked authorizations and checked

for out of area claims.

Generated letters for itemized billing and logged new claims in the system

and database.

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