High School Medical
Resume:
Christina M. Ortiz
Apple Valley, CA 92308 ******@*******.***
OBJECTIVE:
To obtain a position in a fast pace environment in where I can grow and use
my skills and knowledge and education to further enchance my career in this
profession.
EDUCATION:
1987. -High School Diploma-San Andreas High School
2006- West Tech College
SUMMARY: Healthcare professional with 4 years experience, specializing in
the following areas:
Job Summary: Responsible for consistently and accurately adjudicating
claims in accordance with policies, procedures and guidelines as outlined
by the company policy. Process claims according to all CMS and DMHC
guidelines. Review, research and process complex claims. Handle
recalculation of claims due to incorrect claim payments or where additional
information has been received. Investigate and complete open or pended
claims.
. Responsible for payments
. Processing and adjudicating of paper /scanned and EDI
claims
. Professional/Hospital HMO
. Eob,appeals and denials
EXPERIENCE:
12/2006-Present DPM/Choice Medical Group, Apple Valley, California
(An IPA providing services to the High Desert area for
over 20 years)
Claims Examiner III / (Professional Claims)
. Perform pre-check audits for payment accuracy and errors.
. Processing and Adjudicating commercial and senior CMS
1500/UBO4.
. Medical Claims Examiner. Review, evaluate, process or deny
claims such as Profees, Lab/Radiology, Skill Nursing,
Outpatient, Inpatient claims. Knowledge of standard claims
coding such as CPT*, ICD*, HCPCS and Encoder Pro,Medicare
Pro,Virtual Auth,Ez-cap
. Adjudicate all claims payments for accuracy and timeliness.
. Assists in weekly check run
. Check authorizations /eligibility
. Experience processing all lines of business (HMO, Medicare,
Commercial
River City Medical Group- 07/0/2009-11/30/2010
.
. Responsibilities: Reviewed adjudicate Medi-cal /Medicare
guidelines claims.
. Authorization and eligibility
. Prepare pre-check audit report.
. Review and deny untimely and possible duplicate payments.
. Adjudicate all claims payments for accuracy and timeliness.
References upon
request
Contact this candidate