Data Entry Customer Experience

Carmen Bayona-Montoya

***** ******* ** #*** *** Nuys CA 91401

Home# 818-***-**** Email: ***************@*****.***

Occupational Skills:

45wpm,10key by touch Collections,follow ups

Bilingual (English,Spanish) Verifications of Benefits

Word,Excel,Outlook,Lotus Notes Authorizations,referrals processing

Medisoft,Brightree,Visitrax HMO,PPO,POS,Medicaid,Medicare

Coding: ICD9 vol. 1,2,3; CPT,HCPCS CCS,Tricare,Champva,SSI,VOC,WC

Claim forms:CMS1500,UB04,ADA,EHR HIPAA regulations

Dental Billing & Coding Cust. Serv, Data entry

Pt scheduling, EOB, EOMB,RA Organize, detail oriented, dependable

Professional Experience:

KAISER PERMANENTE

Configuration Analyst III Burbank 03/2015 to 01/2016

Generate Summary of Benefits Coverage (SBC) documents for plans such as Nationals, Large Groups, Private Exchange etc by analyzing different sources of information (NURF,NPS, CERTS, MARKUPS), placing share costs in the appropriate benefit fields by utilizing benefit codes; the use of KP calculator to place values in the Coverage Examples; responsible for conducting edits on Student Plans, PEX, National, Large Groups, SBCs produce by the auto system, response to FAQ from AAMs regarding changes in benefits, L&E, educating AAMs on how to use/open Sales Connect cases or request for translations, monthly uploads of SBU plans into CARS system, release of SBC being suppressed in PSP, producing Redlines for SBU, QA of documents produced within the department, QA translations (Chinese/Spanish), processing deadlines and any other special project. Contributor to the department SOPs.

AJILON STAFFING

Claims Processor Burbank 06/2014 to 03/2015

Generate Summary of Benefits Coverage (SBC) documents for plans such as Nationals, Large Groups, Private Exchange, by analyzing different sources of information (NURF, CERTS,NPS,MARK Ups), use of KP calculator and placing of values in the Coverage Example fields, edits on Student Plans, Carve Outs, releasing of KPIC SBCs “suppressed” in PSP.

ACCREDITED RESPITE SERVICES Woodland Hills 03/2013 to 01/2014

Referrals/Applications Specialist

Answer phone calls from members, caregivers, County workers, Service Coordinators;

contact with members, Service Coordinators, Regional Centers through phone, fax, email. Processing referrals and authorizations, verification of benefits, issuing and mailing of respite applications, processing of same applications. Obtaining approval from Regional Centers on special cases. Scheduling of potential caregivers for CPR/FA classes

Processing of daily mail, filing, faxes and any special projects as they are assign.

CHILDREN HOSPITAL OF L.A Los Angeles 10/2011 to 12/2011

Financial Counselor1/Pulmonary Clinic

Processing of authorizations and referrals

Processing of doctor, nurse, social worker, dietician’s notes

Data entry of patient/member demographics into Hospital data base

Keep record/log of all pending referrals and medical prescriptions

Verification of benefits via phone and/or websites (Medi-cal,CCS, Anthem, Blue Shield, Molina, L.A Care). Work deadlines, heavy phones, daily mail, scheduling of patients.

HEALTH ADVOCATES, LLC Sherman Oaks 03/2004 to 01/2011

Medi-cal Eligibility Analyst

Screened, completed, filed and follow up on Medi-cal applications

Contact with members, County Workers, District Managers, State Disability Workers

Verification of benefits prior to process for payments, prepared files/accounts for appeals

Ordered death/birth certificates, medical records, progress notes from hospitals

Meet deadlines on daily basis, processing mail, faxing, and copying, scanning, filing.

ST ELIZABETH CATHOLIC SCHOOL Van Nuys 09/2002 to 06/2003

Teacher Assistant-Kindergarten

Teached academic subjects following school syllabus

Distributed, collected, graded homework and tests, processing daily mail

Yard duty, field trips, special projects, parent-teacher conferences

Teacher substitute, school culmination.

UNITED CONCORDIA- Woodland Hills 07/2000 to 03/2002

BLUE SHIELD OF PENNSYLVANIA

Customer Service Rep/HMO Dep

Answered phone calls (English-Spanish) from members, providers, other departments

Verification of benefits on different dental programs

Explain benefits/limitations to members, providers; settled disputes regarding charges

Worked dental claims, process daily mail, filing, special projects as assign

Meet company’s expectations regarding handling of calls and knowledge of products

EDUCATION:

UEI College-Van Nuys Campus Diploma 03/2011 to 11/2011

Medical Billing and Insurance Coding

Universal Computing Institute Diploma 11/1995 to 05/1996

Microcomputer Operations Specialist

Van Nuys Adult High School Diploma 1985

EXTERNSHIP AND CERTICATIONS:

GREEN LINE COLLECTORS/WORKWERS COMPENSATION

Clerical-Entry Level: Assisted Billing Department with all clerical duties such as copying, faxing, scanning, daily mail, log in/registration of new accounts, insurance payment verification, filing, log in of all medical prescriptions.

CPR and First Aid Certify, American Red Cross and America Heart Association

HIPAA Compliance for Health Care Professionals course

References upon request

Contact this candidate