Data Entry Customer Service

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-***-****

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

General Manager for Caliber Collision

Mike Parrent 805-***-****

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

Business Owner for Falcon Roofing

Marla Johnson 805-***-****

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

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