CHERYL A SANTA

Novato, CA ***** 775-***-****

ad19fz@r.postjobfree.com

Healthcare Senior Analyst

“Leveraging Healthcare & Claims Professional Relationship to increase Profitability & Drive Business results”

Motivated, self-starter, enthusiastic professional with 36 years of extensive experience in handling claims, billings, collections and customer service in both government and commercial lines of business. Well-driven in following the basic standards specifically using personal protective equipment (PPE) in the different establishments to comply with the basic health and safety COVID-19 regulations. Proficient in attaining solid knowledge and understanding of dental and medical terminology providing high quality coaching techniques to team members and performs as a flexible and well organized team leader. CORE COMPETENCIES

Health Care Expertise Health Maintenance Organization (HMO) Process Improvement Coaching & Training Troubleshooting Claims Data Entry Skills Excellent Verbal & Written Communication Skills Data Analysis Research Expert Multi-task Ability PROFESSIONAL EXPERIENCE

CLAIMS CUSTOMER SERVICE, REFUNDS & RECOVERY 2012 - 2021 Meritage Medical Network, Novato, CA

● Acquire claims payments and pursues recoveries through contact with various parties and/or claim recoupments.

● Seize ingoing/outgoing claims, customer service calls, health care plans to identify and resolve claim issues

● Process all levels of medical claims including Medicare, Medi-cal and commercial lines of business.

● Assigned with various weekly assignments and tasks, including posting, balancing, reconciling, provider overpayment checks, health plan recovery checks to submit to the finance department for deposit.

● Appointed with various monthly assignments and tasks, including preparing spreadsheets for all recoverable services to be billed to multiple health plans for the reimbursement while following up on all claim denials.

SENIOR CLAIMS ANALYST 2011 - 2012

Alameda Alliance, Alameda, CA (temp Job)

● Analyzed and reviewed different claims for accuracy, completeness, and eligibility to be reimbursed precisely and timely.

● Processed the refund checks, adjusted incorrectly paid claims, answered provider appeals and concerns and all customer service calls from the medi-cal, Medicare, and other registered commercial insurance plans.

● Reviewed requests for claim denial, clear data and claim exceptions, and ensured deficiencies are flagged correctly.

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SENIOR CLAIMS ANALYST & CONSULTANT 2011

BroadPath Healthcare (Staffing Agency), Tucson, AZ

● Offered advice to businesses to improve their performance in terms of operations, profitability, management and strategies

● Assigned in posting, balancing and reconciling payments for the finance department at Blue Cross/Blue Shield NC

● Conducted necessary research, surveys, and interviews while analyzing statistics to gain an understanding of the business

● Managed, reviewed and approved legal referrals to ensure consistency with established claims management protocols.

● Presented recommendations for improvement using business models to test them and present findings to the client.

SENIOR CLAIMS ANALYST, CONSULTANT & AUDITOR 2004 - 2010 Jacobson Solutions (Staffing Agency), Chicago, IL

● In charge of hospital claims, historical trend analysis and reports related to process implementation

● Compensated the medical insurance claims for the state of louisiana employees and federal government employees

● Completed and oversaw a variety of professional assignments to review, evaluate, authorize and monitor services provided and received while maintaining and updating records.

● Provided necessary technical support to deliver superior customer service levels and ensure compliance with regulations in support of the companies revenue and profitability objectives and overall business plan.

● Audited and adjusted all the medical insurance claims for Blue Cross/ Shield of North Carolina's IPP host plan

● Performed extensive research to determine the overpayment/underpayment of all clients profit and loss including Aetna, Wellpoint, Mt States Blue cross, Cigna, Humana, Blue cross of WA and Unisys.

● Involved in assisting and controlling the cost of processing claims and contracting policyholders about claims and providing necessary information regarding the amount of benefits when necessary.

● Assigned in auditing, adjusting, and posting all the claims for the departments finance and business operations.

SENIOR CLAIMS ANALYST

Amerigroup, Tampa, FL 2009 - 2010

● Improved an organization's position or profile by helping to solve problems, manage change and improve efficiency.

● Processed the particular government Medicaid claims for the states of Texas, New Mexico and Nevada.

● Reviewed necessary insurance claims for the accuracy, completeness, and eligibility of all data and information

● Utilized all advantageous analytical skills to project potential losses and make recommendations to limit risk.

● Provided administrative support and coordination for aspects of patient care for both new and/or established patients.

● Followed up all the collections from the health plans for the outstanding debts to update all the company records.

● Presented assistance for the billing of Medicare, Medi-Cal, and all commercial lines of business via paper and electronic submissions for 6 oncology/ hematology physicians, 2 nurse assistants, and chemotherapy treatment center.

● Performing the daily cash/check deposits, setting up new patient accounts, and verified insurance coverage while obtaining prior authorizations for mandated services for the department's continuous processes.

SENIOR CLAIMS ANALYST, TEAM LEAD & CONSULTANT 1996 - 2007 Claims Services Resource Group (Staffing Agency), Dallas, TX

● Established proof of loss by studying medical documentation, information and conducting investigation of questionable claims

● Utilized a broad knowledge from all the lines of business and state law requirements needed for the process from all clients, namely Blue Cross/Shield of Ohio, John Alden of Arizona, PCA of Texas, and Kaiser of California.

● Provided excellent customer service for all the policyholders, providers, agents, and coworkers in the department.

● Processed the necessary claims for medical, dental, vision, hospital, and nursing facilites using extensive knowledge and terminology, ICD-9 coding, pre-existing conditions and dental pre-estimates.

EDUCATION & PROFESSIONAL DEVELOPMENT

Accounting classes 1982

College of Marin, Kentfield, CA

Cosmetology License: Cosmetology 1983

Marin Beauty College, San Rafael, CA

High School Diploma: Business Math 1980

San Rafael High School, San Rafael, CA

TECHNICAL SKILLS

Microsoft Office Suite (word, Excel, Powerpoint), Its, ASI, Medical Manager, Gateway, Diamond, Facets, Acclaims, Proclaims, Windows, Rims, Luminex, Quick Cap

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