Mataniu Tualaulelei

**** ******* ***, **********, ** 916-***-**** ad21si@r.postjobfree.com

Professional Summary

Accurate, precise medical industrial reporter claims with over 20 years experiences in the medical field. This

experience has afforded me a well-rounded skill set that includes strong verbal and written skills which makes me as valuable asset to my organization.

Skills

Verbal and written communication Self-starter

Proper phone etiquette Time management

Good Customer Services Team liaison

Attention to detail Problem solver

Kaiser Permanente Hospital - Occupational Medicine Clinic Roseville and Sacramento, CA

Work History:

Cashier Receptionist, February 2000-April 2000 Sacramento, CA

Assist patients that presents New or Follow up registration/check-in policies and procedures.

Verify and/or update all demographic information.

Check in patients by following check-in policies and procedures and using the check-in systems or manual visit records when the systems are down.

Obtain a patient medical record number when necessary.

Medical Claims Industrial Reporter, April 2000-March 1, 2023 (retired)

Kaiser Permanente Hospital - Occupational Medicine Clinic Roseville and Sacramento, CA

Obtain all necessary patients, employer and carrier information needed to complete required industrial from (EPIC) system.

medical reports: Doctor's First Report of Occupational Injury or Illness, Form DLSR 5021 (''DFR'') and

Primary Treating Physician's Progress Report, Form PR-2 (''PR2'')

From physician's notes, abstract information necessary to prepare industrial medical reports

Notify the appropriate Business Office personnel of industrial services not previously billed

Investigate notification of previously unidentified industrial cases from worker’s compensation insurance

claims administrators, Business Office personnel, employers, patients and others`

Review medical records to identify services related to the application

Create industrial medical reports necessary to support Kaiser Permanente lien claims

Utilization Review, Patient Referral, Authorization Review etc. Medications, MRI, CT Scan

Create RFA’s form with any authorization regarding Patient Medications, MRI, CT Scan etc.

When finalized Doctor’s Reports DFR/PR-2 and RFA’S form, fax all documents to Claims Adjustor and

Nurse Case Manager of Workers Compensation Insurance Company

Lead Medical Biller, October 1993-Nov. 1999

Genex Services, Workers Compensation Bill Review

Analyze, review and process payment on medical bills from providers, hospitals, ancillary medical providers

Rehabilitation services and pharmacies, to significantly reduce costs to clients (HCFA) 1500 Forms.

Responsibilities include System entry, utilizing medical bill review software, adjudicate and process

Workers’ Compensation Medical bills payment according to California Workers’ Compensation fee

schedule and beyond.

Education

High School Diploma: 1985

Samoana High School Pago Pago, American Samoa

Sacramento City College 1988-1991

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