Teresa Rodriguez

*** **** ***.

Stockton, CA ****7

Phone: 530-***-****

ac2xfi@r.postjobfree.com

Professional Summary

A Medical Claims Examiner with experience in both Commercial and Medi-Cal Insurance Industry. Able to thoroughly investigate and evaluate insurance claims to either pay or deny depending on each individual contract.

Core Qualifications

Strong analytical skills

Clear written and verbal communication

Knowledge of medical terminology and medical billing codes

Attention to detail

Ability to work both independently and as a team player

Employment History

Claims Examiner

10/2016-Present Jacobson Solutions Chicago, IL

This is a work from home project. I examine and process Medicaid claims for various states, adjudicate and adjust both Professional and Facility claims, research and correct errors for proper payment. Processed all types of claims, Emergency rooms, Labs, Anesthesia, Ambulance, Radiology, Durable Medical Equipment, Primary Care, EPSDT and timely filing. Ensure member eligibility is accurate as well as provider information. My expertise in processing claims as well as self-discipline to work from home is a key in both the positions I have held thus far with the Jacobson Company.

Cook/Kitchen Help

08/2015 to 10/2015 Arroyo’s Café Stockton, CA

Cooking and serving meals. Prep and stocking for next shift.

Human Resources Supervisor

09/2013 to 05/2015 Podesta Packing LLC Linden, CA

Reviewed applications to ensure proper qualifications were met; contacted selected individuals and processed all new hire paperwork. Maintained schedules according to workload necessity. Conducted daily attendance and periodic head count to verify all employees were in designated areas/tasks. Update records for 250 employees to reflect performance and provide prime information as needed. I am excellent in working and maintaining a professional friendly relationship with coworkers and employees alike, to ensure a positive work environment.

Claim Examiner

06/2013 to 08/31/2013 CompuGain ACS-Xerox West Sacramento, CA

As a member of the Medical Suspense Department I was responsible for adjudicating and or adjusting claims while ensuring claims were handled appropriately and in a timely manner. Identified processing errors and corrected such errors to pay claim according to online payment system; maintained accuracy and departmental productivity goals.

Claim Adjuster

06/2010 - 03/2013

Correct Care Integrated Health Inc.

Sacramento, CA

Adjudicated and adjusted claims while ensuring claims were handled in a timely manner; researched claims for correct information for processing; member eligibility for DOS ensures authorizations were attached. Finalized claims via Manual Pricing guidelines including researching claims history for previously processed claims when needed. Calculated DRGs using software programs, 3M’d facility claims, posted back end scanning. Audited the No Pay lock to ensure denials were accurate. Maintained accuracy and production goals.

Claims Processor

01/2001 - 04/2009

Capitol Administrators

Rancho Cordova, CA

Examined and processed medical and dental claims. Researched claims history for previously processed claims when needed. Priced claims according to individual commercial health plans and adjudicated claims also ensure the standard for claims

Resolution process was met accordingly to individual contracts. Identified processing errors, maintained accuracy and departmental productivity goals at all times.

Claims Examiner

04/2003 - 10/2008

Health Net Inc.

Rancho Cordova, CA

Examined, adjudicated claims while ensuring claims were handled in a timely manner. Ensured that claims had correct information needed for processing, member eligibility for DOS was accurate, services had required authorizations attached, Manual claims pricing which also included researching claims history as to not duplicate claims payments, always maintained departmental accuracy and productivity goals.

Data Entry/ Claims Processor BlueShield of California Woodland, CA

06/1999 – 5/2001

Entered data from CMS 1500/UB 92 claim forms to online system ensuring all information was correct, including patient information, physician information CPT codes, DX, Rev, and HCPC codes were appropriate for services rendered. Examined and processed facility claims by reviewing each claim and researching claims history for previously processed claims, routed claims to proper departments for processing. (Dental; COB; etc.)

SKILLS

60WPM, 15000KPH

ANSWERING AND DIRECTING INCOMING CALLS

FAX, COPY MACHINE,SCANNER, MULTI-PHONE LINES

WORD, EXCEL, OUTLOOK

HR AND ADMINISTRATIVE

BILINGUAL

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