Stephanie Diaz

***** ******** *** *** # * Norwalk CA 90650

562-***-**** adthdp@r.postjobfree.com

Summary

Claims Examiner with 8 years of experience handling Medi-Cal, Commercial and Medicare line of businesses. Able to handle complex claims following company guidelines, procedure and policies, most of all complete understanding of industry best practice with a minimal of claims error. Thorough understanding of benefit coverage and member’s co-pay/co-insurance Highlights:

Knowledge of Medical terminology Data Entry Setting up Providers Credentialing CPT/ICD 9&10 Claim Examiner II Faucets, Qnext,

Offcie Ally EZ-Cap Other Home based Software

Professional Experience:

Caremore (TEMP) Cerritos Ca June 2017 to January 2018

• Processing and/or adjusting health claims in accordance with claims policies and procedures

• Researches and analyzes claims issues.

Los Angeles Firefighters Local 1014 (Temp) El Monte CA November 2016 to May 2017 Claims Adjuster 1

● Adjust incoming claims, verify eligibility, examine each claim for information such as coordination of benefits, accident details, potential third party liability situations, workers’ compensation impacts, and Medicare eligibility. Conifer Health Solutions Anaheim CA November 2015 to Oct 2016 Patient Account Rep, (Contract with Health Care Scout)

● Responsible for all aspects of follow up and collections, including making telephone calls, accessing payer websites. Identify issues or trending and provide suggestions for resolution.

● Verify claims adjudication utilizing appropriate resources and applications.

● Initiate telephone or letter contact to patients to obtain additional information as needed.

● Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory So CA united Food & Comm workers Union Cypress CA August 2015-October 2015 Claims Examiner II (Contract with ISO Staffing -)

● Process and adjudicate PPO claims for queue

St Joseph Heritiage

Claims Examiner (Temporary) Orange CA May -2015 – July 2015

● In-load claims batches as assigned

· Process claims consisting of professional, emergency,x-ray,lab,pathology

● Radiology, PT,OT

Western Growers Irvine CA October 2014 – May 2015

Claims Examiner II

● Processed and adjudicated PPO claims consisting of professional, emergency, x-ray, lab ambulance

● Responsible for loading paper claims and helping with back log as needed Coast Health Care Lakewood CA March 2014 – October 2014 Claims Examiner II (Contract with ATI Staffing Westminster CA))

● Uploaded medical claims in order to process

● Viewed, analyzed, and examined claims for punctuality

● Created daily spreadsheets to work assigned accounts Accountable Health Care Signal Hill Ca December 2014 – February 2014 Claims Examiner (Contracted with ATI Staffing Westminster CA)

● Processed EDI claims from queue

● Adjudicated claims as needed from queue

Alta Med City of Commerce CA April 2013 – December 2014 Claims Examiner (Contracted with Health Care Talent Winter Park Fl. )

● Research UM clams for correct authorization and verify information was correct

● Sent authorization’s for DR’s approval

● Set up fee schedule for providers as needed

Synermed Monterey Park CA April 2012 – December 2012 Claims Examiner (Contracted with Aerotek Staffing Rosemead CA)

● Processed EDI claims from queue

● Viewed, analyzed, and examined hospital/professional claims for punctuality

● Created daily spreadsheets to work assigned accounts Molina Healthcare Long Beach CA April 2007 – September 2011 Claims Analyst

● Acknowledged and uploaded grievances/appeals into database in order to process

● Administration duties, arranging meetings, set –up conference rooms, preparing meeting agenda’s

● Worked with Government contracting and Compliance setting up meetings Safeguard Dental Irvine CA January 2005 – May 2007 Data Entry

● Entered Dental claims from EDI submission

Education:

● Whittier High School (GED)

● UEI – Huntington Park Ca ( Business Administration)

● Received certificate for best attendance,and Mentor

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