Andres Riley

**** *********** **** 714-***-**** acrh1v@r.postjobfree.com

Objective

To secure a position where my extensive claims experience can be utilized and persuasive communication skills to contribute to the success of the organization and continue my professional growth.

Education

AA JUNE 1986 PARKWAY WEST TECHNICAL SCHOOL-OAKDALE PA

Major: MARKETING

Skills & Abilities

Complete Claims School Brea, CA)

Certification Medical Claims Examiner April 1991

Dean Vaughn Course –Medical Terminology

LA Care Health Plan Proficient Supervision Certificate April 2013

Microsoft Excel,Word,PowerPoint

Experience

PDR INTAKE LEAD LA CARE HEALTH PLAN 9/24/11-12/26/2014

Supervision of 15-20 employees assigned daily work assignments

Inventory excel reports sent to management daily.

Reviewed audited data files before loading on PDR Intake system for completion.

Reviewed and processed special projects appeal claims

Provided customer service assistance to providers with hospitals, medical groups, DME offices and also with LA Care provider relations department and more.

RECOVERY CLAIMS-OVERPAYMENTS ATI TEMPORARY-SCAN HEALTH PLAN 06/2009-7/31/2011

Analyze claims for overpayment verify correct payment made

Send letter to provider requesting overpayment tickle file created to monitor and track return payments.

Excel spreadsheets provided to management for review and also current report of pending outstanding overpayments.

CLAIMS AUDITOR KAISER PERMANENTE 12/2004-02/2009

Auditing of processed claims verifying correct payment, authorization issued, provider address correct etc.

Various types of claims hospital, office, DME, and high dollar.

Additional information can be provided