Sign in

Administration Workers Compensation Legal Medical Insurance

Pasadena, California, United States
November 30, 2017

Contact this candidate


Carol Jimenez 626-***-****


Thank you for taking the time to review my Resume. I am currently pursuing a position in your industry. If I may draw your attention to the well rounded experience with a background in Administrative, Litigation and Collections, Workers Compensation Insurance/Claims, Accounting, Office Management/Supervisory, Human Resource-Payroll, Legal Assistant, and Real Estate.

Skills to be utilized with your company, with the vision and goal of delivering all skills to enhance positive productivity for the success between all divisions of your company. Although just a sneak peek at the value of hard work, while working smarter with effectiveness and Solution driven, my abilities, strengths, knowledge, and all skills, will be demonstrated vigorously with your company. In addition, mirrors instructions. Adapts to various atmospheres and personalities. Is a self starter-self motivator, and is team oriented. Comfortably teachable- trainable in new challenges and changes. Extremely capable of assisting and training others in new endeavors. Is trustworthy and accountable with responsibilities. Ability of working under pressure with deadlines, while demonstrating confidentiality and professionalism at all times. Understands and can articulate the client’s most critical issues-challenges. Sets and aligns time commitments to priorities. Possess ability to earn trust in relationships with others by consistently demonstrating integrity (loyalty, honesty, consistency, and reliability), knowledge and professional competence. Squarely focused to achieve agendas, goals and meet commitments. Bilingual Spanish.

Litigation & Collections Specialist

OFFICEWORKS - Pain Diagnosis And Treatment Dr. Brian Gwartz May, 2016

Case Research & Analysis

High volume of Workers Compensation Patients Insurance cases 1

Constant interaction with Insurance Adjuster and case Attorney

Compose Demand Letters and Settlement Letters

Insurance Verification-Eligibility

Occasional Translator English/Spanish

Update case and Insurance information in Medisoft/Office Hours/Charts

Process Credit Card Payments and assist in Billing phone calls

Preparation of Worker’s Compensation Court Cases for Hearings such as Lien Conferences to Trials

Preparation of Workers Compensation case files ranging from Thousands to Multi- Million Dollar accounts

Prepare and submit outstanding medical billing and balances due per Official Medical Fee Schedule to various Insurance Adjuster and or Defense Attorney

Prepping each account on Excel spreadsheets per itemized line charges for each Date of Service entry to determine account value

A/R, submit Demand for payment

E-File DWC EAMS Liens and Declaration of Readiness to set for case Hearings

Communicate with Applicant Attorney and Defense Attorney case to negotiate a settlement and prepare Settlement Confirmation

Submit billing to Insurance for payment or additional payments and/or settlements

Prepare Appeal Forms, prepare appeals letters with all supporting documentation such as Medical Reports-Narrative/PR2, EOB/EOR, SBR-1 Forms, Billing Statement and Itemization-1500 HICF, Proof of Service and submit to the insurance carrier for payment as well as to prepare for up coming calendared case court hearings

Work through each file in keeping timely schedule of importance and priority while maintaining all W/C accounts

Keep Hearing Calendar, Work with Hearing Attorney and Representative assigned on cases to provide all case support by preparing case and case support 2

High volume of communication with Insurance Adjuster and Attorney for negotiations, settlement offers or settlements or status and next course of action

Receive Workers Compensation payments and post payment to appropriate accounts and appropriate Date of Service to update/reconcile balances and accounts

All other office administration duties relating to Work Compensation and Billing

Occasionally assist Front office cover phones, walk-ins when needed. Litigation & Collections Specialist Accurite Medical Management Services Paramount, CA Kimberly Robinson/Patricia Mclane 323-***-**** May, 2015 May 2016

Litigation & Collections Specialist negotiating Workers Compensation medical providers and physician’s Billing accounts.

Resolving bills and/or liens for Biosciences, a commercial and research leader in personalized medicine which has a portfolio of patent-protected genetic tests that help physicians answer some of their most important concerns to improve care and reduce costs. These fields of genetics in neuropsychiatry and pharmacogenetics are emerging as a very important factor in evaluating medications influencing the mesolimbic reward system of the brain.

Other Clients include Chiropractic accounts who provides care to patients suffering from back pain, neck pain, headache, sciatica or have been injured while working indexed with most Medical Provider Networks and Insurance Companies providing evaluation and management of work related injuries.

Serving as subject matter expert in Medical Lien, EAMS E-Filing, and Settlements.

Contact Insurance Adjuster and Defense Attorney to resolve Settlement and/or case status. Negotiate to resolve billing with Insurance Adjusters and/or Attorney for providers or physician-client.

Work file from beginning to end.

Create Calendar for court hearings, gather, analyze supporting case documentation and crucial data, continually update case notes and case status in System.

EAMS Research (Electronic Adjudication Management System), Case Search and E- Filing.

Bill payments-EOB-or EOR (Explanation of Bill Review), payment follow prior to 30 days 3

and follow up on past due, consistently follow through is key to determine next and best course of action to resolve bills Resolve prior to scheduled Lien Hearing via phone contact with Defense Attorney or Insurance Adjuster.

Draft and submit Demand Letters with bill and supporting documentation, draft and submit Confirmation Letters.

Exceptional negotiator-A/R.

Case Research & Anysis.

On-Call Hearing Appearances for local Workers' Compensation Boards -Medical Lien cases proving-up case for overdue provider billing.

Constantly reviewing and evaluating all documentation including medical reports AME- QME-PQME, C&R Compromise and Release and all other reports.

Knowledge of SB863 one of Governor Brown’s landmark reforms, Senate Bill 863. The bill makes wide-ranging changes to California’s Division of Workers’ Compensation system, including increased benefits to injured workers and cost-saving efficiency.


Knowledge of Medical Fee Schedule and California Labor Codes Law-ACOEM Guidelines, OMFS and Medical Provider Network Process MPN.

Understands medical and terminology, CPT, ICD-P, RX pricing & dosing using AWP & NDC's and billing codes.

Computer Savvy, Proficient Various Software such as Microsoft Word, Google Docs, Drive and Calendar Office, Excel, Billing Software Office Alley, Practice Mate, E-Fax, Electronic Filing, with 10 Key by touch, update and Maintain Files, Email.

Train others in Lien filing and other procedures.

Follows all policies, procedures and legal mandates including HIPAA, client confidentiality, releases of information, protected health information (PHI) and client files

My Banks Capital LLC. Inland Empire, CA Michael Barco (909) 909-***-**** September 2013 –May 2015 - Forward On-Call

Legal and Real Estate Transactions Executive Administrator Business Assistant to small 4

business owner. Assist in income property and new investment purchases.

Assist small business owner with personal ongoing separation of assets.

Discuss and drafted proposals and offers.

Preparation for hearings, reviewing discovery, review, analyze and respond to opposing party notices. Dictation and type up documentation.

Assist with providing subpoena documentation for court or opposing counsel.

Obtained Real Estate Broker to best fit quality of needs.

Negotiate sales commission fees of the primary residence of Plaintiff and Defendant's Court Ordered Real Estate sale.

Liaison between client, Real Estate Broker, Escrow, Title and Lender.

Established new financial account for Real Estate sale funds from sale of primary home to be held for re-investment property.

Assist in Business permits/license, renewals.

Assist in all aspects of process of new investments providing necessary documentation for lender, Escrow, Attorneys throughout process until closed.

Research variety of investments properties continually seeking the goal of prospective invoice property investments.

Assist in all business Accounting, A/R -A/P, invoicing etc.

Knowledgeable and proficient in most software such as Microsoft Word, Office, Excel and QuickBooks. Fax, Mail, with 10 Key by touch, daft and reply to emails etc.

All office support and functions as needed.

Office Management-Supervisory, Administrative and Human Resource Administrator - Litigation & Collections Specialist

Assertive A/R Solutions South Pasadena, CA Arthur Becerra 310-***-**** August, 2007 February, 2014

Litigation & Collections, Serve as Subject Matter Expert in Medical Lien, Hearing & Calendaring Workers Compensation cases.


Maintain scheduling of Calendar-Court Hearings manage *Hearing caseload Accounts Mandatory Settlement Conference through Trail.

Knowledge of SB863 one of Governor Brown’s landmark reforms, Senate Bill 863. The bill makes wide-ranging changes to California’s Division of Workers’ Compensation system, including increased benefits to injured workers and cost-saving efficiencies.

On Call-Occasional Court Hearing Representative court appearances.

Exceptional negotiator.

Prepare case Exhibits and supporting documentation to prove-up case detail.

Some examples of accounts worked are Ortho, Chiro, DME, Sleep, Toxicology, Pharmaceutical, Topical, Physical Therapy, Surgery Centers and other medical providers.

Constant communication with Insurance Adjuster, Defense and Applicant Attorneys to negotiate settlements and resolve bills.

A/R-Resolve bills prior to schedule court hearing. Draft Demand or Settlement Confirmation Letter with Bills and supporting documentation submitting all to Insurance or Attorney to resolve.

Draft and promptly submit Court Hearing Reports & Court Orders-Settlement Stipulations.

Case Research & Anysis.

Electronic-Filing of Liens-DOR -Hearings through EAMS (Electronic Adjudication Management System).

Work up provider assigned accounts alpha by gathering, analyze all supporting case documentation-data continually updating case notes and status in system.

Knowledge of MFS Medical Fee Schedule, California Labor Codes Law, ACOEM Guidelines and OMFS (Official Medical Fee Schedule). Knowledge of Medical Provider Network Process MPN.

Understands medical terminology, CPT, ICD-P, RX pricing & dosing using AWP & NDC's and billing codes.

Reviews and Evaluates Compromise & Release and all supporting medical reports such as AME, QME & PQME, Ratings and other medical reports.

Create, maintain, and enter information into databases.

Reconsideration and Appeals. Accounts Receivable bill payment-Explanation of Bill and 6

Explanation of Review EOB-EOR-Payment Follow Up-Follow through is key to determine next-best course of action to resolve matter.

Follows all policies, procedures and legal mandates including HIPAA, client confidentiality, releases of information, protected health information (PHI) and client files.

*** Management -Office Management/Supervisory and Assistant to CEO:

Manage-supervise to maintain operations, protocol and productivity.

Provide training to current staff, orientation and training to new staff and Interns.

Report directly to CEO.

Assist other department supervisors to align with company goals.

Head up and maintain intern Program. Constant supervision of 30-50 employees and outsource/field court representatives.

Coordinating workload productivity delegating proper workload to staff.

Assist all staff inquiries, duties and concerns.

Delegating appropriate workload to proper staff while identifying talent in specific areas.

Accounts Payable-pay bills, invoices, handle deposits and other payable as needed.

Invoicing (internal and external) gathering data for invoicing of clients and Collector independent contractors and Court Representatives.

Keep records of collections and disbursements of Collectors and staff to ensure accounts are balanced.

Human Resource-perform payroll functions, such as maintaining attendance records, timekeeping processing-submitting payroll electronically and manually-1099 & W2.

Assist in new company procedure and protocol process.

Liaison to Client to assure authorization & satisfaction, participate in meetings, seek client authorization, extremely client customer service oriented.

Related education coursework intensive training in Work Comp Litigation & Collections.

Various Legal Secretarial & Administrative Support to various department Management.

Manage projects, contribute to all goals & objectives of company.

Correspondence, Electronic Mail, Postal Mail, Compose-type distribute meeting notes, 7

reports such as presentations or expense, statistical, or monthly reports.

Proficient computers for various applications & software database management CMS, Microsoft Word, with 10 Key by touch, Excel, QuickBooks, Fax, Mail, Draft Emails and all office support and functions as needed.

Savvy with office equipment.

Complete duties with Ethical-Positive Reputation.

*Organizational skills

•Proficient in working effectively in a fast paced environment while juggling multiple tasks at a time. Well versed in budgeting, inventory maintenance, time management and task prioritization. Strong organizational skills targeted at maintaining electronic and paper files, tracking deadlines, maintaining calendars and scheduling meetings. Good teamwork abilities targeted at working in unison with others in a bid to ensure success of departments.

*Management skills

•Has manage and supervise 30-50 employees and outsource/field representatives coordinating workload productivity delegating proper workload to employees. Proven background in new hire interviews, orientation, guidance and induction into activities, train, monitor, coach, reviews and termination process. Effective in calendar keeping and appointment scheduling with proven ability to schedule appointments involving more than one department effectively. Assist as office management ensuring productivity, responsibilities in smooth operations in absence of CEO, A/R-Accounts Payable bills and invoices, bank deposits, Invoicing internal and external gather data for invoicing of clients, keep records of collections and disbursements, keep track of Collectors and Staff progress, ensure accounts are balanced, Human Resource-perform payroll functions, such as maintaining attendance records, timekeeping processing-submitting payroll electronically and manually prepare 1099 & W2. Organization of company events. Liaison to clients to assure authorization & satisfaction. Liaison between CEO, other management and staff. All other requested duties or as needed.

*Computer skills

•Competent in PC operations and software including, but not limited to, Windows, internet Research, MS Word, Office, Outlook, CMS, Excel, QuickBooks and billing software Office Alley, Practice Mate, Office Hours, MediSoft, E-Fax, Electronic Filing and capable of adapting to new software quickly. Demonstrated skills in computer maintenance and basic troubleshooting of windows. Knowledge of creating and managing spreadsheets, 8

knowledge of using data entry software and performing data entry tasks with accuracy and precision 10 key by touch ability to handle and interpret complex accounting data using various accounting software. Capable of calculating mathematical functions in order to provide support on different budget documents. Typing accuracy with 55-60 WPM typing speed.

*Technical skills

•Operational knowledge of the functioning of various office equipment including facsimile machines, communication systems, scanners and photocopiers and other office equipment. Full command on various data entry and file cataloging systems. Technically savvy with comprehensive knowledge of creating spreadsheets and presentations and maintaining calendars and tracking important deadlines. Able to repair minor faults in office machines, printers and scanners etc. Firsthand experience in resolving minor troubleshooting computer issues

.*Communication skills

•Expert in maintaining productive written and verbal communications with all levels of management, clients, stakeholders, vendors and staff as needed. Proven collaborative skills to facilitate teamwork. Proficient in issuing and presenting monthly and weekly progress reports. Track record of effectively serving as a liaison between management and employees. Exceptional written communication skills aimed at preparing and dispensing routine correspondence, filing memos, proofreading legal documents and handling transnational documents. Proficient in using the Internet. Email and search engines.

*Interpersonal Skills

•Demonstrated ability to build rapport quickly. Customer oriented attitude towards work with profound ability to interact effectively with others. Analytical skills good attention to detail with ability to develop timeline project blueprints. Proven ability to comprehend and follow instructions accurately. Exceptional research abilities aimed at determining similarities findings by investigative precedents. Able to handle communication with clients, providing support to different departments, staff members personally and by virtue of email, telephone calls in a professional manner.

*Administrative Skills

•A highly motivated Administrator with a strong vision to achieve successful outcomes for clients and departments through precedence research abilities and completion of task focused. Track record of assisting task to perform complex administrative duties. Able to manage extensive word processing tasks with special focus on handling revisions to complex documentation or reports. Results-driven, dependable administrator with a demonstrated ability to take initiative to spot problems in the process while managing complex schedules. High level integrity with a great sense of urgency aimed at working 9

successfully under pressure. Strong familiarity with terminology and processes. Service- oriented, diligent administrator with years of experience in organization. Proven track record of following procedures, retaining necessary professionals and assembling materials needed. Special talent for performing general or secretarial duties, processing mail, managing calendars, opening accounts and organizing and maintaining electronic and paper client files. Accomplished and results-oriented individual with extensive experience in rendering services and preparation. Highly developed skills coupled with knowledge of research directives. Excellent grammar, punctuation, proofreading, and composition skills. Comprehensive knowledge of the office, legal judicial system, Collections and Billing and other business and its working. Adept at handling administrative tasks in any environment. Substantial knowledge of legal, medical and business terminology and its effective use in correspondence and conversation. Demonstrate ability to understand legal, medical or business jargon and transcribe dictated legal, medical or business material with accuracy. Exceptional research capabilities aimed at researching precedents and other information important to particular task. Unique ability to provide ongoing support to staff with a huge array of practice areas. Strong interpersonal and communication skills aimed at interviewing documenting evidence. Handling priorities at hand, understanding of a variety of forms and documents and its nature with proven ability to prioritize, prepare correspondence in an effective manner, skilled in multiple sources of data in order to create and demonstrated expertise in organizing a professionally maintained office environment.

*** Previous Experience

Real Estate Realtor Licensed from 1999 to 2009

Realtor -Keller Williams Chino Hills, CA, Realtor -Help U Sell Prestige Properties, Chino Hills, CA

New Tract Home Builder -Sales Manager Host -Griffin Communities Corona, CA Office Management & Real Estate Apprentice -Action One Realty Investments-Arcadia, CA

*** Education

Real Estate Academy Los Angeles, CA Real Estate Principles & Business Real Estate License -Real Estate Realtor July 1999 ELAC East Los Angeles College -Monterey Park, CA

Business Administration/Marketing/Accounting

Community Service


Burrito Project South Pasadena, CA

Volunteered prepare and distribute Skid Row Down Town Los Angeles, CA Inter-City Volunteers Pomona, CA -A Servants Heart Volunteer for needy families Pomona CA

Volunteered as Tea Room coordinator, Holiday Meals, Women's Day of Beauty, and other community events.

Inland Hills Church Chino Hills, CA

Volunteered as a Women's Coach -Inland Hills Church Chino Hills, CA Coached and Apprenticed Leaders for Small Group Women's Groups 11

Contact this candidate