GU

GRACE URIBES

ad10af@r.postjobfree.com 909-***-**** San Bernardino, CA. 92404 WWW: Bold Profile

Dependable and service-oriented professional with expertise in processing and coding claims, ensuring all required criteria are met before eligible payments are issued to claimants. Proven track record of meeting targets, with strong analytical skills and attention to detail. Well-versed in working and collaborating in a fully remote professional environment.

Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience.

Customer Service

Research

Analysis

Schedule Management

Complaint Resolution

Microsoft Office

Microsoft Teams

Multiple systems logins utilizing different multi-factor authentication applications.

3270 HHSDC Session/DOS-based systems.

Zoom Online

Peoplesoft

Administrative Skills (Medical Office Admin)

ICD-10/PCS

CPT

HCPCS

EHR

Claims

CMS-1500(02-12)

COB

Eligibility of Benefits

ABN

UBO4/837P

Denials

Authorization

Rx refills

Referrals

48 WPM

Billing Skills (Medical Office Admin)

Medicare

4

HMO/PPO

Tricare

IEHP

Blue Cross

Blue Shield

Workers Comp

Disability

Clinical

Vitals

Venipuncture

Injections

12-Lead EKG

Hematocrit

Capillaries

HCG Test

Blood Typing

Cultures

Surgical Tray

Pap Tray

Auto-clave

Case Management Tracking

TEKsystems

Case Manager

05/2023 - 09/2023

Remote

Ensures program applicants are continuously updated regarding the status of their program application

Frequent, diligent, and professional communication required Obtains a working knowledge of applicant needs and program eligibility Summary

Skills

Experience

criteria

Understands program requirements and other key objectives Understands program processes from start to finish and communicates those processes clearly to applicants

Gathers applicant documentation and uploads to program system of record

Records all communications in the program system of record Strong customer service skills and knowledge of customer service best practices

Ability to maintain confidentiality of program information Ability to use analytical skills to interpret and evaluate information Received EDD UI during gap in employment.

Claims Specialist

08/2022 - 03/2023

Remote

Evaluate unemployment insurance claims data for potential eligibility issues

Make outbound calls as needed to interview claimants for information verification to resolve any noted claim issues or discrepancies Review unemployment insurance claims for weekly benefit amounts and payments

Process claims with confirmed eligibility issues for potential adjudication and determination by the

California Employment Development Department

Document claimant interactions, along with actions taken to supplement case notes

Collaborate with subject matter experts to address unique issues Analyze claim information to determine the cause of outstanding Issues and determine next steps to resolve these issues. Maximus Remote

Deferred ER Protest Agent

03/2014 - 05/2022

Agent Maximus, Nd, Century Technologies

Remote

Call Center Agent

05/2013 - 01/2022

Club Demonstration Services

Sales Advisor

01/2021 - 12/2021

Setup and take down demo station as required

Prepped and cooked food according to specifications Used proper food handling and temperatures

Conducted demonstrations that introduced customers to New products

Operated microwave, hot kettles, and electric skillets. Homemaker

10/1990 - 12/2020

I took care of the home and family

Budgeted finances and expenses

Cooked and cleaned

Washed, dried, and put dishes away

Washed, dried, put laundry away

Used vacuum cleaner and

Registrar of Voters Took inbound/outbound calls to potential voters 02/2020 - 02/2020 Transferred calls to various departments Took down messages for department heads when unavailable Operated multiline phone system.

M.D.

MOA Extern

08/2018 - 10/2018

Assisted with the front office duties with posting Prime Care and HMO payments into patient accounts

Into the Electronic Healthcare Record software

Called patients regarding his/her referral status

Returned telephone calls for those that left messages Scanned and filed patients' referrals into the Electronic Healthcare Record Logged information into each account as required

Checked patients Inland Empire Health Plan and Prime Care eligibility Requested clinical notes from other specialties and procedure results. Medical Office Admin

10/2018

PAL Charter Academy

School, Diploma

06/2004

Concorde Career College

Medical Assistant

06/2003

Concorde Career College

Diploma

Education and Training

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