NANCY MATUSKA

**** ********** *****, ******** ** 95219

209-***-**** admizh@r.postjobfree.com

Summary of Skills

●Training

●Strong Analytical Skills

●Excellent written and grammatical skills with a meticulous focus for detail

●Curriculum Development

●Microsoft Office Programs

●Power Point

●Facets

●Skype

●HIPPA

●Sharepoint

●Teams

●WebEx

●Interviewing

●Track Attendance/Kronos

●Critical thinking

●Customer service

●Active Listening Skills

●Presentation

●Strategic Planning

●Medical Terminology

Professional Experience

Robert Half - Dorfman Pacific Stockton CA 95206

January 2020 - July 2020

Business Systems Analyst

Aptean

Apprise

Standard Operating Procedures development

Excel

Conduent/ CA Medicaid Fiscal Intermediary West Sacramento, CA 95605

October 2018 – September 2019

Outreach and Education Provider Trainer

Updated and created Medi-Cal provider training workbooks, updated and created power point slides for training purposes. Traveled to and participated in provider training seminars. Scheduled

meetings via WebEx. Hosted and recorded provider Webinar trainings. Tracked Attendance.

Presentation Skill

Power Point

Strong Communication and Interpersonal Skills

Curriculum Development

Technical Competency

Prepare educational materials

Assist in Provider Training Seminars and Webinars

Coordinate logistics for training delivery

Schedule WebEx meetings

Conduent/ CA Medicaid Fiscal Intermediary West Sacramento, CA 95605

February 2018 – Oct. 2018

Business Analyst

Updated and created Medi-Cal department Standard Operating Procedures (SOP), spreadsheets

for purposes of tracking providers that elect to opt out of receiving paper RADs. Reaching out to

providers to educate them on the PDF RAD option and provide them with instructions as to how

to access and understand the PDF RADs. Attend monthly meetings and provide status updates to

DHCS lead for this project.

Microsoft Excel Spreadsheet fluent

Created Standard Operating Procedures

Assist in development of material promoting new product of Medi-Cal

Technical Competency

Assist providers in enrollment procedures

Training Providers on Outreach and Education

Xerox/Conduent/ CA Medicaid Fiscal Intermediary West Sacramento, CA 95605

August 2013 – February 2018

Reimbursement Claims Analyst

Processing reimbursement claims for Beneficiaries attempting to retrieve out-of-pocket expenses paid to Providers that would have been covered under their Medi-cal benefits. Prepping claims, creating files and assigning service request numbers to track process of the claims.

Customer Service

Strong Communication Skills

Assist with obtaining reimbursement of Out of Pocket expenses

Xerox/Conduent/ CA Medicaid Fiscal Intermediary West Sacramento, CA 95605

January 2011 – August 2013

Customer Care Specialist

Answered phone calls to assist Providers and direct them to Medi-cal website manuals for claims processing information providing claim status.

Assist customer with navigating the Medi-Cal website

Took inbound calls from Beneficiaries

Assisted Beneficiaries with eligibility status and information

Assist customers with claim status

EMMI Stockton, CA 95219

May 2004 – December 2009

Data Entry

Verified insurance eligibility and entered claim information received on CMS 1500 format into

data base.

Data entry of patient insurance information and benefits.

Data entry of CMS-1500 claim form

Verify Eligibility

Practice Management Plus Stockton, CA 95203

March 2001 – May 2004

Billing Specialist

Collected and posted payments from patients, sent monthly billing statements, maintained and

balanced spreadsheets for providers.

Collection and posted of payments from patients

Outgoing mail of monthly billing statements

Maintained spreadsheets for providers

Made arrangement of payment plans for patients

Claims follow-up

Verify Eligibility

Blue Shield of CA El Dorado Hills, CA

October 1985 – September 2000

Claims Trainer/Auditor/Claims Examiner

Began my employment as a Claims Processor. Promoted to Trainer position where I trained new

hires in a classroom setting with presentations, computer programs, and claims

processing manuals utilizing Blue Shield guidelines. Audited claims and provided feedback to

staff as well as auditing claims suspending payments of $25,000 plus for hospital services.

Assisted staff members with claims processing issues. Communicated with providers regarding

claims status and assisted them with understanding additional information required in order to

receive payment for claims. Tracked Attendance. Interviewed potential new hires.

Trained new employees on duties and procedures per company standards including operation of company equipment’s.

Performed quality audits and provided feedback and guidance to staff members

Trained on claims processing manuals with guidelines from Blue Shield

Adjudication of claims utilizing Blued Shield guidelines

Coordinate and present bi-monthly meetings with claims staff and management

Communicate with providers regarding difficult claims issues

Initiate recoupments of claims overpayments

Assist in development of claims adjudication instructions and guidelines

Interviewed potential new hires

Tracked Attendance

Delta Benefits Plans Stockton, CA 95203

March 1981 – October 1985

Claims Processor

Manual processer of claims. Determined eligibility and types of insurance plans that applied to

the Member, including if services were covered or not per the plan benefits’ booklets. Manually

calculated if deductibles, co-insurance, and stop loss or yearly maximum benefits paid out were

met. Applied payment/denials information received from other insurance, with the end result

being manually calculating amounts to be paid or denied for each claim.

Manual processing of claims, determination of covered services, deductibles,

co-insurance

Identifying if yearly max benefits paid out were met

Manual calculations for claims to be paid

Assist insured members in understanding their benefits

Education

At Home Professionals Online Course Medical Terminology

Horizon Stockton CA Excel

Humphries College Stockton CA Intensive Grammar

Sac Medical Training Sacramento, CA Certified Nurse’s Assistant

AA Stagg High School Stockton, CA High School Diploma

References

Evonne Palaez Former Director, Manager Conduent 916-***-****

Jaynie Le Former Business Analyst Partner 916-***-****

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