Medical Customer Service

Tanya PortenBay

Email: ********@*********.***

Address:

City: Sacramento

State: CA

Zip: 95829

Country: USA

Phone: 916-***-****

Skill Level: Any

Salary Range:

Primary Skills/Experience:

Energetic Medical Insurance Claims Processor with over 2 years experience in processing Medi-Cal and Commercial medical claims in a timely manner

Educational Background:

High School Dipolma from High Tech Institute, Sacramento CA 1/2001 to 9/2007 (Medical Billing and Coding Program)

Job History / Details:

Professional Summary

Energetic Medical Insurance Claims Processor with over 2 years experience in processing Medi-Cal and Commercial medical claims in a timely manner

Skill Highlights

Knowledge of insurance carriers including HMO's, PPO's Managed Care & Government Programs, insurance reimbursement and medical terminology

Front office Skills: Appointment scheduling, Insurance authorizations and pre-certification, verifying patient eligibility, data entry and in office collections

Computer Skills: Medisoft, Medical Manager, EZ Cap, Host Access, Excel, Word, Type 65 wpm, 10 key/Alpha Numerica 13000 ksph

Professional Experience

April 2011 to September 2012

Landmark Health Care Sacramento, California

UR Rep ll

Accessed the different queues pertaining to various LOB's that contained review decisions completed by Landmark's Clinical Peer Reviewers several times throughout the day verifying: Members name, Id number, DOB, Provider name and address, ICD-9 Code(s) were valid and covered, the dates of services requested and the number of visits and procedure codes requested. Made sure the appropriate bullets were applied, that the free form text was correct, checked to see if X-Ray and or Herbs were requested and that the member was eligible for such services, made sure that there were no overlaps for certain LOB's. If the work item contained incorrect data, I routed the work item back to the appropriate queue to have letters regenerated. I assisted with the 3rd letter release of the day, checking a final time to make sure that the decision was on the correct letterhead, that there were no spelling errors. I was in charge of the call reports that took place 4 times a day, along with several suspense reports that were generated daily to ensure that all outstanding items that came up on the reports were resolved within a timely manner.

February 2008 to April 2011

Pacific Staffing Sacramento, California

Temporary Employee

During my time as a temporary employee I worked for several different clients such as Mercy Medical Group in Rancho Cordova, Rivercity Medical Group in Sacramento and Landmark Healthcare in Sacramento when I was hired on with Landmark in April of 2011. I performed a variety of duties such as entering and retrieving claims data from their computer systems, processed Medi-Cal and Commercial medical claims, requested refunds for over payments when needed, provided support for customer service and adhered to the companies policies, procedures & guidelines, maintained strictest of confidentiality.

September 2007 to December 2007

Data Support Services Sacramento, California

Medical Office Clerk (Externship)

Duties included: Filing EOB's and claims, performed misc. office duties, input patient demographics, gained knowledge of the different financial classes, followed up on open claims and posted charges

Education and Training

2007 High Tech Institute Sacramento, California

Medical Billing and Coding Program

Certificates of Completions: HIPPA and OSHA

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