Lupe A. Valdez

ad4x3s@r.postjobfree.com 626-***-****

PROFILE

I am a motivated, efficient and easygoing Southern Californian woman with experience in medical billing and claims adjustment, who is searching for a position that involves portable skills or multitasking. I prefer positions which would allow me to work remotely but am also open to traditional positions. I am looking for the right opportunity to advance my career while utilizing my skills and experience.

EXPERIENCE

REMOTE- SR. CLAIMS ANALYST/ELIGIBILITY, ROBERT HALF INC - UNITED HEALTH CARE/CASA COLINA SURGERY CENTER; COLUMBUS, OH — 08/31/2021-12/2022 Applied claim reductions and denials based on industry standard guidelines. Adjudicated professional claims to ensure accurate payment through CES review. Monitored error queues and denial queues for error corrections. Obtained authorizations from insurance companies. Responsible for filing and retrieving patient records, preparing new files, opened and distributed mail supplies. CLAIM SPECIALIST/DATA ENTRY/MAILROOM, KONNECT RESOURCES; SANTA FE SPRINGS, CA — 02/17/2020 – 08/27/2021

Data entry duties included collecting data from various sources, maintaining electronic records (UB-04 ) & (CMS-1500). Claims with coding errors/inconsistencies were pended or a mail-back with complete supporting documentation cover sheet for each member missing/inaccurate billing information. Assisted in the mailroom using excel sorting/ labeling by Regions/LOB/Acknowledgement/Upheld CMS/Authorizations/Undeliverable letters.

CLAIM EXAMINER, ATI STAFFING SOLUTIONS; FOUNTAIN VALLEY, CA — 08/06/2018 – 02-14-2020

Researched, identified, resolved, and responded to inquiries from internal departments regarding outstanding claims, related issues and identified root causes of claims issues/ deficiencies. Handled misdirected claim inquiries. Reviewed claims for appropriate referring physicians and billing information (PNF listings). Processed Institutional/ Professional claims into Xpress/Core systems. Data Entry Non PDR’s/Scanned/Posting Checks. Etc.

REMOTE- SR. ASSOCIATE, HEALTHCARE & AMP INSURANCE; OAKLAND, CA

— 03/15/2012 – 04/22/2017

Worked with various health insurance products such as PPOs, HMOs, KP, and CMS/Medicare. Handled DOI issues, student benefit claims, visiting member claims, self-funded claims review. Researched corrected claims adjustments, duplicate bills, and did general claims trouble-shooting. Adjusted claims with regard to a members’ accumulations if the member had a share-of-cost plan. Investigated, researched, and adjusted as needed in paying claims that may have been processed incorrectly either by system errors, contract changes, or adjudicator errors.

CLAIM EXAMINER /ELIGIBILITY COORDINATOR, ATI STAFFING SOLUTIONS; WESTMINSTER, CA — 09/1996 – 02/2012

Analyzed and investigated reported LOB claims. Determined amounts due to ensure timely adjustments and payments. Reviewed daily audit reports. Complied with HIPAA guidelines. Created authorizations for ER/urgent/direct admissions. CLAIM ADJUSTER, UNIVERSAL CARE; LONG BEACH, CA — 10/2001 – 08/2003 Telecommuted to adjudicate TennCare claims from home. Handled 300-500 EDI claims per day from aging report, using code-review programs to suspend, amend, or release claims in a timely manner. Organized, analyzed and evaluated medical records for proper routing of claims and ensured correctness of provider information to maintain high quality document preparation processing. ACCOUNTING CLERK II, SANWA BANK; MONTEREY PARK, CA — 06/1998 – 12/19/98 Assisted in preparation of financial reports and more complex reconciliation and balancing of accounts. Performed a variety of complex clerical accounting functions. Reconciled bank to ledger activity, generated reports to main offices, provided information to customers, and connected customers with desired party.

CLAIM EXAMINER /ELIGIBILITY COORDINATOR, ATI STAFFING SOLUTIONS; WESTMINSTER, CA — 09/1996 – 02/2012

Analyzed and investigated reported LOB claims. Determined amounts due to ensure timely adjustments and payments. Reviewed daily audit reports. Complied with HIPAA guidelines. Created authorizations for ER/urgent/direct admissions. EDUCATION

High School Diploma

Certification of Medical Terminology

EKG Monitor Technician

SKILLS

• Proficiency with Windows PC applications

• Collections

• Data entry

• Medical Claim Billing

• Eligibility Coordination

• Medi-soft, Excel, Qcare, CHATS, As400, IDX, EZCAP,CORE, XCELYS, Diamond, Trio- Health/Core-Axis Billing and 3M-Encoder.

• Medicare, Medi-Cal,HMO, PPOs, Tri-care ChamPus, and ChampVA among other systems.