Data Entry Customer Service
Resume:
CAB
CYNTHIA ANN BALTES
SUMMARY
****A North St. Somis CA 93066
EXPERIENCE
Regal Medical Group Northridge, CA
February 2017 to November 2021
Claims Project Specialist/Compliance Auditor (Health Insurance)
Applied knowledge of state and federal laws, statutes, and insurance regulations in claim handling.
Interpreted and applied insurance contract provisions. Uses various electronic resources for claim handling.
Responsible for processing and accurately paying 10,000 claims a week on an Excel spreadsheet.
Researched, analyzed, and responded to inquiries regarding compliance, inappropriate coding, denials, and billable services.
Managed the audit process by providing management with an independent and objective evaluation of adherence to company procedures and all applicable state and federal laws and regulations.
Claims Associate III
Medi-Cal, Commercial, Exchange & Medicare California
Analyzed and managed complex or technically difficult claims by investigating and gathering information to determine the exposure of the claim.
Assessed liability and resolve claims within the evaluation.
Calculated and pays benefits due; approved and made timely claim payments and adjustments; and settled claims within designated authority level.
Prepared necessary state fillings within statutory limits.
Processed all claim types and adjustments and also researched and analyzed contracts for payment.
Understanding COB and EOB from different carriers and processing claims correctly.
WellPoint Inc./Anthem, Newbury Park, CA (Health Insurance)
Medi-Cal & Medicare California (January 2015 - December 2016)
Claims Associate III
Claims Associate (June 2000 – July 2012)
Knowledge and use of CPT, HCPCS, and ICD9 codes.
Prepared documentation for audits and also helped with many other department assignments.
Meeting all inventory and quality expectations.
Processed all claim types and adjustments.
Specialized in processing ambulance claims and DME.
Processed professional, DME, Outpatient, Inpatient, Dialysis, Skilled Nursing, Home Health claims, and improved claims processing efficiency.
Research correspondence from Providers and Members.
Responsible for the discovery, validation, recovery, and adjustment of claims overpayments.
Highly detail-oriented individual with excellent customer service and leadership skills seeking a position where I can further my career and knowledge. Accustomed to handling sensitive, confidential records. Flexible and versatile, able to maintain a sense of humor under pressure. Poised and competent with demonstrated ability to easily transcend cultural differences. Thrive in deadline-driven environments. Good team-building skills.
EDUCATION
High School graduate
SKILLS
Results-oriented
Team building
Leadership
Time management
Problem-solving
MS Outlook & MS Word
Excel
Tracy Hodge 805-***-****
adsyq7@r.postjobfree.com
General Manager for Caliber Collision
Mike Parrent 805-***-****
adsyq7@r.postjobfree.com
Business Owner for Falcon Roofing
Marla Johnson 805-***-****
adsyq7@r.postjobfree.com
Team Lead, Professional Claims for Regal Medical Group
Dootson School of Trucking, Ventura CA (Trucking School)
Office Administrator
August 2014 to January 2015
Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information.
Made copies, sent faxes, and handled all incoming and outgoing correspondence.
Worked directly with the customers.
Managed enrollment, scheduling, and general office work.
Handled payments, billing, and sales.
Caliber Collision, Oxnard, CA (Auto Collision Repair)
Office Administrator
October 2012 to July 2013
Processed claims and worked directly with insurance companies.
Managed payroll, accounts payable, and accounts receivable.
Provided customer service, parts invoicing, and scheduling.
REFERENCES
Work for the Veterans/Secretary for American Legion Riders Post 741
VOLUNTEER
WORK
Communication skills
Underwriting
Administrative skills
Auditing skills
Interpersonal skills
Documentation
Data Entry
Reporting
Accounts payable
Accounts receivable
Customer service
Scheduling
Billing
Medical Insurance
Multi-tasking
.
Contact this candidate