Eusevia Victoria Torres

**** * ********** **

Laveen Arizona 85339

ad1goa@r.postjobfree.com

OBJECTIVES

Obtain a position utilizing my professional services, administrative and people skills in an organization with room for growth and advancement.

EXPERIENCE

Experience October, 2015 to Present Health Choice AHCCCS

-Claims adjuster

-Completed adjustments of resubmitted claims

-Completed review and adjustment if necessary of Provider Inquiries

-Reported system issues and processing error trends

-Work provider appeals

-Minor use of Cerner system for member records used to determine everything needed available to sendto medical review

-Train new adjustment processors from scratch as well as updates

-Take provider calls for claims understanding discrepancies and outstanding claims

-Provider Liaison work for JOC calls with provider group AR log of claims denied in error or short paid or billed incorrectly on needed basis with many different providers

Experience 07-24-2006 to April, 2015 Care1st Heath Plan of Arizona

-Thoroughly handle incoming provider and member calls regarding claim status

-Provide customer service with a positive attitude and know to root cause handle each issue

-Provide education where needed. Resolve all providers inquires in a timely and accurate manner

-Ensure that all received calls are properly input to the phone tracking system and that follow-up is performed to fully resolve claim issues

-Provide feedback regarding trends and training needs within the claims department to improve accuracy of claims processing, knowledgeable in Medicaid and Medicare guidelines, accurately process claims in accordance with health plan guidance, company standards, and company procedures

Experience 2004 to 2005 Mercy Care/Schaller Anderson

-Case Management Authorization Specialist

-Access on our pregnant members for High Risk Management, worked closely with Obstetrics offices regarding authorized and claims, help members understand medical and dental benefits

Experience 2001 to 2002 Benesight Health Plan

-Customer Service Resolutions

-Helped members understand medical insurance benefits, out of pocket cost, deductibles, co-payments and Network benefits

Experience 1999 to 2001 Star Administrative Service

-Senior Customer Service Representative

-Fast pace environment handled incoming calls for providers and members

-Helped researched claims and helped members understand medical and dental insurance and benefits

-Loading new employee into the system

Experience 1997 to 1999 Pediatrix Medical Clinic

-Medical Front Office

-Checked in and out patients

-Made charts updated, scheduled appointments, and updated patient information

-Referral Coordinator

-Obtained specialist referral for patients and made appointment

SKILLS

-I have an extensive background in the medical field and provide excellent Customer Service.

-I am bilingual (English & Spanish) I have a cheerful personality

-I am a hard worker, Hones and Dependable, willing to grow within a company, Insurance background and inbound call center experience.

*References available upon request

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