Medical Claims Processor with Compliance Expertise

PROFESSIONAL SUMMARY

Experienced professional with expertise in claims processing,

healthcare compliance, and insurance verification. Skilled in communicating with medical professionals and patients, ensuring accurate and efficient handling of medical claims. Seeking to leverage knowledge and experience as a Medical Claims Processor to support and enhance the operations of a dynamic healthcare team.

Reliable worker with excellent communication, time management, and computer skills. A driven and detail-oriented individual with a desire to use analytical and problem-solving skills to meet goals. EXPERIENCE

Medical Claims Specialist

May 1997 - August 2012 First Health, Tucson, AZ

Customer Support Specialist

February 1993 - May 1997 Convergy, Tucson, AZ

Developed and implemented strategies to ensure compliance with all applicable laws and regulations related to medical claims processing.

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Communicated effectively with internal departments including customer service representatives, sales team members, IT personnel, regarding billing issues impacting customers.

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Documented all findings from investigations into discrepancies on individual accounts or batches of accounts submitted for payment.

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Verified patient information on claims paperwork, checking for and preventing mistakes.

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Communicated with patients by answering questions, providing helpful information and distributing paperwork.

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Efficiently identified customer needs through active listening and questioning techniques.

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Conferred with users, and conducted computer diagnostics to investigate and resolve problems and to provide technical assistance and support.

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CONTACT

520260729

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

Phoenix, AZ 85043

SKILLS

• Claims processing

• HIPAA

• Healthcare compliance

• Insurance Verification

• Communicating with medical Dr

• Communicating with Patients

LANGUAGES

Spanish

Conversational

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LILIA GASTELUM

MEDICAL CLAIMS PROCESSOR

Created detailed reports outlining the status of each technical issue reported by customers.

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EDUCATION

Major Studies

May 1986

SunnySide High School, Tucson Az

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