Customer Service Medical

SANDY M. CODINA

**** ******** **. **** ****, CA *5628

Cell: 916-***-****

*****.******@*****.***

OBJECTIVE

To obtain a meaningful and challenging position that enables me to use

my skills within the Customer Service field and allows for growth

opportunities.

SKILLS:

. Superior Customer Service and phone etiquette skills

. Excellent written/verbal communication and inter-personal skills

. Strong time-management skills, self- motivated with strong

attention to detail

. Ability to prioritize and handle multiple projects simultaneously

to meet deadlines

. Proficient in typing @ 56 WPM and Ten-Key @ 10500 KSPH

. Proficient of MS programs (Word, Excel, & Outlook) and

Intranet/Internet

. Analytical, problem-solving, and quick decision-making skills

. Team player and the ability to work independently with limited

supervision

WORK EXPERIENCE:

October 2011 - Present Heald College

Rancho Cordova, CA

Financial Aid Advisor I

. Provide students with accurate information regarding

application process, loan counseling and their eligibility for

State/Federal financial assistance, alternative financing, contracts

and/or institutional payment plans.

. Determine Title IV eligibility through an approved needs

analysis Financial Aid software system for students requesting

Financial Aid.

. Inform students of their financial obligation, the

institution's financial aid options, and financial policies and

procedures as related to their educational expenses

. Prepares, monitor and follow-up on all status (new, renewal and

refinance) of all pending student loan documents in order to

maintain an accurate accounting of each students financial aid

package through first disbursement.

April 2010 - October 2010 Accent Care Home Health

Rancho Cordova, CA

Scheduling Coordinator

. Received referrals to schedule and coordinate sessions

for the appropriate clinician.

. Called and informed patients a referral has been made for a

clinician to come out and assist.

. Received all transfer/hospitalization/referral calls and

documented into system and notifying

Clinician's with any updated information.

. Received, separated, and organized incoming mail/fax/note

correspondences from

MDs, patients and/or Clinician's.

. Created new patient file and confirmed patient frequency on POC and

scheduled in

Interlink system.

. Entered MD Orders into the system and was back-up for the receptionist.

June 2009 to September 2009 Express Employment - UFCW

Roseville, CA

Medical Claims Adjuster

. Reviewed, analyzed, and processed medical/dental claims for payment

of medical services.

. Processed Medicare PPO claims by verifying accuracy of information

from, determining eligibility under current plan design and

calculating benefits.

. Determined and calculated any under-payments/over-payments by

making any corrections and adjustments.

. Determined whether members had additional medical coverage and

coordinates claims processing with other carriers and TPA's as

necessary.

. Reviewed Medi-care claims, EOBs, and benefit requests for

completeness and complies necessary information from member files

and other sources.

. Performed varied and complex clerical and related administrative

functions.

October 2008 to June 2009 Delta Dental

Rancho Cordova, CA

Claims Processor /Data Entry Operator III

. Entered all necessary claims correspondences from the submitted

Attending Dentist's Statements (ADS') into the operating system.

. Proofread and check claims correspondence for completeness and

accuracy.

. Cleared edits and rejected claims to other job functions.

. Entered data from scanned claims using MACESS application.

. Entered paper and rejected claims to other job functions using

rejection sheets and on-line routing using windows.

. Updated and/or corrected patient's information of claims

August 2004 to January 2006 Health Net Federal Services

Rancho Cordova, CA

Intake Rep I / Referral Representative

. Received incoming mail and processed all medical claim

referral/authorization

correspondence information.

. Proofread for use of grammar, punctuation, vocabulary and

corrected errors as needed.

. Contacted patients and medical providers by phone for all urgent

requests and concerns.

. Validated patient and medical provider's information is accurate

and complete.

. Verified member benefits and entered all data information from

nurses clinical

correspondence including CPT/ICD-9 codes, and DME into the computer

system.

. Met goals and produced results through tracking performance,

improving work processes, and prioritized work and tasks.

. Assisted patients with locating medical provider's by specialty for

health care services.

March 2001 to July 2003 U.S.A.A.

Sacramento, CA

Customer Accounting

. Handled high volume customer phone inquiries in a call-center

environment (ie;

billing, payment arrangements, and general customer

concerns).

. Managed individual P&C billing accounts (ie; updated invoices,

problem solving for billing issues, answered complex customer

complaints, adjustments, credit card payments, and refunds to

customers.

. Handled and processed incoming payments on a daily basis.

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