Dynamic professional with extensive experience, excelling in claims processing and medical record processing. Proven expertise in HIPAA compliance and medical billing, coupled with strong problem-solving skills. Recognized for enhancing workflow efficiency and delivering exceptional support, ensuring client satisfaction and confidentiality in all interactions.
Overview
2026
2026
years of professional experience
Work History
Record Specialist
Legal Monkeys DBA Boomerang Legal
Waco, TX
2025 - Current
Managed electronic medical records data entry with accuracy and attention to detail for 5 law firms.
Assisted in maintaining patient confidentiality while processing sensitive information and getting this information submitted to the law firms.
Supported workflow improvements by identifying discrepancies in record-keeping systems.
Collaborated with healthcare professionals to ensure accurate patient data management.
Developed standard operating procedures for efficient electronic record handling.
Collect medical record, itemized bil6ling statements and radiology films.
Conducted regular audits of records to identify discrepancies and facilitate timely corrections.
Utilized document management software to track changes and updates in legal files effectively.
Assisted in data analysis to support decision-making processes.
Knowledgeable in numerous EMR systems.
Senior Member Services Representative
Blue Cross Blue Shield of Massachusetts
Quincy, MA -Remote
2023 - 2025
Facilitated member inquiries and resolved issues through comprehensive support and detailed information dissemination.
Educated members on healthcare options, benefits, and resources to enhance understanding of plans.
Collaborated with cross-functional teams to streamline service processes and improve member experience.
Mentored junior representatives, fostering knowledge sharing and enhancing team performance.
High volume medical claims processing
Process pharmacy, dental and medical claims
Abide by HIPAA guidelines while ensuring the confidentiality of PHI.
Requested, pulled and interpreted medical records
Maneuvering through several EMR medical, AMS, Carelon, RTMS and PAC radiology system
Have knowledge of ICD codes and the billing process for claims
Vast knowledge of medical terminology.
Assisted with prior authorizations and referrals when needed to complete the claim process
Vast knowledge of durable medical equipment (DME)
Assist with numerous employer groups and direct pay medical, dental and student claims
Verified insurance and assisted with Coordination of Benefits
Developed and maintained a positive customer relations within the company to ensure customer requests and questions are handled appropriately in a timely manner while adhering to a metric system.
Troubleshoot with members when having online account issues and resetting passwords
Used computerized systems for tracking, information gathering and troubleshooting.
Streamlined claims processing by leveraging knowledge of medical terminology, enhancing efficiency and reducing processing times.
Analyzed member account issues and implemented troubleshooting protocols, leading to marked improvements in online user experiences
Coordinated with cross-functional teams to manage high-volume service requests, ensuring seamless communication and timely issue resolution
Maintained accuracy in data entry across various EMR and billing systems, upholding HIPAA compliance and safeguarding patient information Streamlined claims processing by utilizing extensive knowledge of medical terminology, enhancing efficiency and reducing turnaround times
Insurance Service Representative
National General Insurance Company
Farmers Branch, TX - Remote
2021 - 2023
Managed customer inquiries and provided accurate information on insurance policies and coverage options.
Processed policy renewals, endorsements, and cancellations efficiently to maintain client satisfaction.
Assisted clients in filing claims, ensuring timely communication and follow-up throughout the process.
Collaborated with underwriters to assess risk factors and determine appropriate coverage solutions for clients.
Answer all calls; de-escalating the call where appropriate and providing solutions that leave the customer satisfied with the resolution.
Access policy details to determine extenuating circumstances including but not limited to providing coverage information and explanation, answer complex billing questions, process policy changes accurately, and collect pertinent underwriting information to ensure the correct premium is assessed on the policy using AS-400 and ten key alpha/numeric data entry.
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Calculate premiums and establish payment methods.
Call on policyholders to deliver and explain policy, to analyze insurance program and suggest additions or changes, or to change beneficiaries.
Provide superior service by delivering a WOW experience for both independent agents and National General Insurance customers.
Share feedback when training opportunities are identified.
Promote teamwork through consistency, reliability, and group cohesiveness.
Communicate effectively through oral and written communication.
Considered process improvements on a continuous basis and share opportunities with Leadership.
Learning and Development Facilitator
State Farm
Richardson, TX - Hybrid
2016 - 2019
Facilitated training sessions to enhance team knowledge and performance in product offerings.
Developed and implemented process improvements to streamline workflow efficiency across teams.
Collaborated with cross-functional teams to align development strategies with organizational goals.
Analyzed feedback data to identify areas for program enhancement and participant engagement.
Facilitated virtual and instructor lead new hire onboarding classes.
Performed administrative tasks that support internal processes for the department.
Provided technical support and coordination for learning events.
Provided technology support for the learning management system and other software and tools that support learners and business areas.
Provided customer service to a variety of audiences internally and external to the department.
Provided administrative support, learning event/projects coordination and technical support to L&D and business areas.
Administrative Support included: exam center proctoring, room scheduling, records maintenance, floor support, and invoice processing.
Learning Event Support included: preparing learning materials, collaboration with business areas and facilitators, communication coordination, and classroom set-up. Technology Support included: building and maintaining items in learning management system, and testing of learning objects, and providing general support on technology.
Worked in collaboration with various L&D functions and business area learning teams to complete tasks as assigned, or as generated, by the business area and developed and/or contributed to specialized/project work as assigned and based on capacity.
Handled highly sensitive issues and maintained confidentiality.
Traveled to assist with the set-up and tear-down of training events.
Possess strong PC skills, including direct experience with Microsoft Word, Outlook, PowerPoint, Excel, Outlook, Amadeus, Skype for Business
Knowledge of eLearning systems and tools (My-Block, Captivate, HTML5