Professional Summary

Skills

Work History

J T

**** ** **** *******, *****, Florida 33174 • Home: 305-***-**** • Cell: 305-***-**** • ac87i3@r.postjobfree.com An experienced bilingual billing claims and case management professional with 10 + years' experience in the Health Care Industry possess strong ability for research of denied claims' knowledge excellent research skills. I have extensive history of working with all types of claims insurance and dealing directly with Hospitals and Physicians offices to obtain claims resolution. Have the ability to work in a fast paced environment and multi-tasking for increased productivity. Hospice, ICP, Waiver programs, SSADI & SSI

disability, excellent knowledge of rules and

regulations

Microsoft Office, Word Perfect.

ICD-10, ICP and HC-PCS Coding.

Problem-solving abilities

Strong critical thinking skils

Detail Oriented

Bilingual English & Spanish

CPR Certified

HIPPA Certified.

Medical Records Coordinator, 12/2018 to 04/2019

Cano Health – Miami, Florida, United States, Florida Responsible for analyzing the validity of signatures and efficiently processing requests for release of medical information via fax, email or walk in request from clinics, physicians offices, insurance companies for HEDIS, and attorney, when ordered for pertinent authorized parties. Field Technician, 06/2018 to Current

Ciox Health – 15458 n 28th Ave, Phoenix, AZ

Responsible for to scan medical records from various medical facilities via-predesignated process by using the Iron Key or used the company provider scanner. Medical retrieval for Medicare & Medicaid risk adjustment HEDIS & RADV audits. EMR system used.

Nextgen Health, Athena Health, Advance MD, Dr Chrono, Eclipse, Qualifacts. Education

Disability Specialist, 03/2003 to 08/2017

Nthrive aka Adreima – 500 Salisbury Rd #460, Jacksonville, FL 32216, Florida Responsible for interviewing and determining eligibility for individuals in need assistance with there medical bills.

Developed and establish factors on each individuals case in compliance with program requirements, for ICP, Waiver program, Hospice, and Medicaid, also county assistance program. Performed initial client assessment and analysis to begin research process of each disability case. Med with the Department of children and Families to dispute wrong fulled denied coverage for clients .

Assist the Medical adjudicators at Social Security, to provide them with evidence for a timely medical decision for disability.

Responsible for management of high profile accounts that were in excess of Million dollars. Maintained database with average of 200 to 400 accounts, and it could reach up too 800 at one time. Hearing Coordinator / Medicaid, 06/1991 to 02/2003 Hayt, Hyat & Landue – Plantation, Florida

Med with Department of Children and Families to dispute wrong fully denied coverage for clients in needs of medical treatment.

Responsible in providing the evidence according to the programs rules and regulation, to over turn denials.

Developed and establish factor on each case in compliance to the law and regulations. Provided training to newly hired, served as a designated " Go to Person" for management and employees.

Certificated Billing & Coding : Medical Front Office Procedure, 2018 Florida Career College - Miami - Miami, FL

ICD- 10

ICP - Coding

HC-PCS

Business Management: Certificated of Management, 1995 Mount Saint Mary's University - Los Angeles, CA

High School Diploma: 1978

Herbert Hoover High School - Glendale, CA

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