Referral Specialist Medical Assistant

Marilyn D. Dictado

****-**** *** **

Seattle, WA 98106

**************@*****.***

RESUME:

Objective:

To work in a challenging environment that allows me to apply my analytical skills and utilize my medical knowledge and health insurance industry experience.

EXPERIENCE:

08/1997- 03/31/2019 Kaiser Permanente Seattle, WA. (Group Health Cooperative)

SPECIAL CLAIM RESEARCH AND ADJST:

Review, research and adjust claims paid or denied incorrectly due to incorrect provider, CPT Codes and provider billing errors. Research overpayment and underpayment made due to incorrect subprovider number used.

Resposible in processing Special Projects from Managers, Coordinators and Professional Reps.

Help Provider Assistance Unit answer provider as well as costumer calls. 08/1995-08/1997 Medalia Healthcare LLC. Seattle, WA. CLAIMS REFERRAL SPECIALIST:

1

Load referrals and claims into the system.

Sends letter to consumers confirming scheduled appointment dates. 02/1990- 03/1997 King County Medical Blue Shield (Regence Blue Shield).

REFUND/ADJUSTMENT SPECIALIST:

Initiate and resolve refund inquiries, apply monies received to appropriate claims and accounts.

Coordinate benefits with other insurance and pursue subrogation with insurance companies, lawyers and subscribers.

Investigate for Workers Compensation Recoveries on potential State Industrial cases.

Update membership eligibilties and benefits.

EDUCATION:

03/2006 - PIMA Medical Institute Renton, WA.

Certication- Medical Assistant

03/1980 - Pines City Doctors Hospital, Baguio City Philippines Professional:

Bachelor of Science in Nursing.

REFERENCES:

Tammy Evans - Supervisor- Claims Adjustment Unit

Kaiser Permanente, Washington

Office- 206-***-****

2

Tammy Blair - Manager of Operations, Quality & Controls. Kaiser Permanente, Washington

3

Contact this candidate