Medical Claims Processor
Resume:
Kim Lugo
Objective
To secure a Medical Claims position with an established and growing healthcare organization.
Education
GED - La Puente High School, 1984
Work Experience
INDEPENDENCE MEDICAL GROUP 10/2017 – 02/2018
Claims Examiner – Temp to Hire through ATI
Processed medical claims, HMO, facility and professional claims, worked on Crystal Reports transferring to Excel spread sheets, verified eligibility and benefits, worked on EZ Cap.
INLAND EMPIRE HEALTH PLAN 08/2016 – 03/2017
Claims Processor – Temporary
Processed medical professional claims for Medi-Cal, processed additional claims as secondary, processed manually depending upon contracts, requested additional information as needed, processed specific claims connected to LOA’s, verified member eligibility.
BROADPATH HEALTHCARE SOLUTIONS 10/2015 – 11/2015
Medicare Appeals Coordinator (Virtual temporary assignment
JACOBSON SOLUTIONS 05/2013 – 12/2014
Claims Processor
(Virtual temporary assignment. Jacobson is an outsourced agency for Blue Cross/Blue Shield)
Processed facility and professional claims for New York groups.
Submitted provider letters, made adjustments as needed, worked correspondence, checked benefits and eligibility prior to submitting payments.
ANTHEM BLUE CROSS 07/2008 - 10/2012
Claims Examiner
Processed facility and professional claims for Commercial PPO, HMO and Medical insurance. Submitted provider letters, made adjustments as needed, worked correspondence, checked benefits and eligibility prior to submitting payments.
ARCADIAN MEDICAL 06/2008 – 07/2008
UM Coordinator / EZ Cap (Direct hire, left to return to Claims role)
INLAND EMPIRE HEALTH PLAN 11/2007 – 07/2008
ATI Temp to Hire Assignment 05/2007 - 11/2007
Claims Processor
Processed claims for Healthy Families and Medi-Cal. Made claims adjustments as needed. Verified benefits prior to sending payment.
Other Positions:
NAMM of California / UM Tech / 10/05 – 03/07
ANCHOR MEDICAL GROUP / Referral Coordinator / 01/05- 10/05
PROMED / Authorizations Coordinator / 09/2002 – 11/2004
Temp to Hire through ATI 09/2002 -01/2003 / EZ Cap
KPC GLOBAL / Authorizations Coordinator / 2001 / EZ Cap
HEALTHCARE PARTNERS / Authorizations Coordinator / 2000 – 2001
EMPLOYEE HEALTH SYSTEMS / Authorizations Coordinator / 1997 – 2000 / EZ Cap
Other Skills - Customer Care, Adaptability, Efficiency, Accuracy, Computer skills,
Communication, Tact, Teamwork, Time Management, Multitasking, Positive Attitude, People-Oriented, Quality driven; Organizational Skills
Awards
Anthem Blue Cross - Katz Award - for 100% accuracy Award – 2012
Monthly Awards for 100% accuracy (6+ worth of certificates/awards)
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