Medical Billing Coding
Resume:
Tinamarie Guevara
Professional Summary:
● Senior Claims Examiner with a proven track record processing and auditing claims in the Healthcare Industry
● Able to perform complex audits of electronic claims for payment integrity in alignment with regulatory strand timelines
● Knowledgeable in Medicare, Medi-Cal, RVS, CPT, ICD-9, ICD-10, HCPCS CMS 1500 and UB-04
Professional Experience:
PIH Health, Whittier, CA
Senior Claims Examiner
07/2019 - Present
● Performing complex audits of electronic claims for payment integrity in alignment with regulatory strand timelines, business policies, appropriate coding, and system configuration
● Maintain current knowledge of all change regulatory requirements within Medicare and Medi-Cal
● Evaluate problems and errors in work with appropriate staff to resolve them
● Knowledge of medical coding, RVS, CPT, ICD-9, ICD-10, and HCPCS
● Understanding of medical claim forms: CMS 1500, UB-04
● Knowledge of Encoder Pro And crystal report
● Knowledge of HIPAA compliance rules and policies
● Manual calculations of procedures not adjudicated by claims system
● Record information on claim files such as copayments and deductibles; updating and/or correcting to ensure accuracy
● Medicare Compliance
Independence Medical Group, Corona, CA
Medical Claims Examiner
03/2018 - 07/2019
● Performing complex audits of electronic claims for payment integrity in alignment with regulatory strand timelines, business policies, appropriate coding, and system configuration
● maintain current knowledge of all change regulatory requirements within Medicare and medical
● Evaluate problems and errors in work with appropriate staff to resolve them
● Knowledge of medical coding, RVS, CPT, ICD-9, ICD-10, and HCPCS
● Understanding of medical claim forms: CMS 1500, UB-04
● Knowledge of Encoder Pro And crystal report
● Knowledge of HIPAA compliance rules and policies
● Manual calculations of procedures not adjudicated by claims system
● Record information on claim files such as copayments and deductibles; updating and/or correcting to ensure accuracy
CRDN, Rancho Cucamonga, CA
Claims Adjuster
09/2017 - 03/2018
● Communicate with the policyholder to arrange an on-site visit
● During our visit we will assess the level of damage to help adjusters develop a scope of loss
● Creates an inventory of all the items at the loss site including detailed notes and photos
● Immediate Needs Service returns necessary items in 24 hours
● Open line of communication with policyholders and contractors and provide an accurate time estimate of when our work will be completed reduce the risk of disputes
● Providing precision and clarity is important
Visiting Angels, Chino, CA
Caregiver
06/2015 - 06/2017
● Assist with care for the client including bathing, dressing, incontinence care
● Assist with doctor’s appointments, medication reminders and blood pressure intake
● Meal preparation and light housekeeping
Education:
American Career College, Ontario, CA - Diploma in Medical Billing and Coding, 2018
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