Medical Biller/Coder and Claims Specialist
Resume:
G C Guadalupe Karina
Corrales
Phoenix, AZ ***** 480-***-**** **********@*****.***
PROFESSIONAL
SUMMARY
To obtain a rewarding and challenging position as a Medical Biller/Coder, Benefits or Claims Specialist where a highly motivated and enthusiastic individual as myself can become a valuable member of a health care team. Customer care professional with proven history of enhancing customer satisfaction and addressing inquiries efficiently. Focused on team collaboration and achieving positive outcomes, adaptable to changing needs. Skilled in communication and conflict resolution.
Diligent with solid background in customer care. Adept at resolving customer issues and improving service processes. Demonstrated skills in communication and problem-solving.
SKILLS • Bilingual- Spanish • Medical Records
• Patient Charting • HIPAA Regulations
• Medical Billing • Claims Processing
• Medical Office Software • Medical Terminal
• CMS-1500/UB-04 Claims • ICD-10/CPT Coding
• Insurance Billing • Microsoft Office
• Anatomy/Physiology • Data entry
• Call center experience • Customer service
• Inbound customer service
PROFESSIONAL
EXPERIENCE
CUSTOMER CARE REPRESENTATIVE 09/2024 to 02/2026
UCLA Health Los Angeles, CA
Resolved customer inquiries through effective communication and problem-solving techniques.
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Implemented process improvements to enhance customer satisfaction and service efficiency.
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Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
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• Managed high call volume with exceptional professionalism and efficiency. Responded to customer needs through competent customer service and prompt problem-solving.
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Built rapport with customers through active listening and empathetic responses, fostering positive relationships.
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Enhanced customer satisfaction by promptly addressing inquiries and resolving issues.
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• Navigated multiple computer systems and applications to find information. Utilized CRM systems to accurately track customer interactions and update account information.
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Streamlined call response times for improved customer experience through effective communication techniques.
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• Logged call information and solutions provided into internal database. Actively participated in weekly team meetings, discussing challenges faced as well as solutions implemented towards improving overall departmental performance.
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Implemented feedback from supervisors to continuously improve performance and enhance customer care skills.
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Conducted follow-up calls to ensure complete resolution of customer concerns and verify satisfaction levels.
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Conducted customer satisfaction surveys to gather feedback and identify areas for improvement.
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• Investigated and resolved customer inquiries and complaints quickly. Educated customers about billing, payment processing and support policies and procedures.
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Provided exceptional support to patients by resolving inquiries and concerns efficiently.
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Streamlined appointment scheduling process, reducing wait times for patients significantly.
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• Managed 100-150 calls per day
CODER 06/2023 to 06/2024
Aurora Behavioral Health Tempe, Az
• Coding and auditing of charts
Using ICD-10-CM, providing Coding Clinic, clinical indicators, and documentation support to staff and physicians
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• Reviewing and auditing charts for quality documentation Streamlined coding processes, improving accuracy and efficiency in claim submissions.
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Led training sessions for junior coders, enhancing team knowledge and performance.
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MEDICAL BILLING AND CODING STUDENT 01/2022 to 03/2023 Carrington College Phoenix, AZ
Gained skills to work as a medical biller/coder administrative secretary in healthcare.
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Demonstrated skills and knowledge necessary to perform medical coding and process medical insurance billing and claims within the health care
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setting.
Performed clerical functions and communicate with other professionals, patients, and visitors in the health care setting. Apply critical thinking, collaboration, and communication.
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Developed comprehensive study plans to enhance academic performance and engagement.
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Collaborated with peers to organize group study sessions, fostering a supportive learning environment.
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CUSTOMER SERVICE REPRESENTATIVE 09/2020 to 10/2021 Valor Global Phoenix, AZ
Maintaining a positive, empathetic, and professional attitude toward customers at all times.
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• Processing orders, forms, applications, and requests. Keeping records of customer interactions, transactions, comments, and complaints.
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Diplomatically handling customer complaints and referring them to the appropriate individual/unit for resolution.
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• Ensure customer satisfaction and provide professional customer support. Managed high-volume call queues while maintaining service quality standards.
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Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
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Resolved customer inquiries through effective communication and problem-solving techniques.
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Managed complex customer interactions, ensuring satisfaction and timely resolution of issues.
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Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
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Met customer call guidelines for service levels, handle time and productivity.
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• Handling 50-100 calls per day
INSURANCE AGENT 06/2020 to 11/2020
Fred Loya Insurance Phoenix, AZ
Develop marketing strategies and promote all types of new insurance contracts or suggest additions/changes to existing ones.
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Breed productive relationships to create a pool of prospective clients from various sources by networking, cold calling, using referrals etc.
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Evaluate business or individual customers' needs and financial status and propose protection plans that meet their criteria.
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• Maintain bookkeeping systems, database and records. Constantly update job knowledge and learn about new products and services.
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Developed customized insurance solutions to meet individual client needs.
• Conducted comprehensive policy reviews to ensure optimal coverage for clients.
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• Handling 10-20 calls per day
LEASING AGENT 09/2019 to 06/2020
AJ Employment Phoenix, AZ
Meet with prospective renters and take them on tours of the units that fit their criteria.
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Gather required paperwork that clients will need to qualify for the apartment.
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Preparing leasing documents for potential renters using property standards and regulations.
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Handling the collection of rent payments, security deposits and application fees.
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• Manage all deals from opening to closing.
Facilitated tenant screenings and lease signings, ensuring compliance with policies and regulations.
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Managed property listings across multiple platforms to maximize visibility and attract prospective tenants.
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• Managed 5-10 calls per day.
CUSTOMER SERVICE REPRESENTATIVE 07/2018 to 09/2019 Alliance RX Walgreens Prime Tempe, AZ
Receive phone calls/emails from clients, pharmacies, and/or physician offices.
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Troubleshoot claim processing problems and/or inquiries in the claims adjudication system.
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Complete new/renewal Prior Authorization requests for specialty & non- specialty drugs.
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• Assist members needing copay assistance for brand medications. Reach out to members to assist in a change of Rx to a more cost-effective generic alternative.
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Trained new staff on company policies, procedures, and best practices for customer engagement.
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Implemented process improvements that enhanced service delivery and reduced response times.
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• Managed 60-80 calls per day
EDUCATION Medical Billing and Coding Certificate Medical 03/2023 Carrington College, Phoenix, AZ
REFERENCES References provided upon request.
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