Andrew Molina
Summary
Proven leader with a track record of enhancing operational efficiency at MPS X-Ray LLC through expert staff management and meticulous training. Excelled in customer service, significantly improving client satisfaction and loyalty. Skilled in HIPAA compliance and insurance verification, adept at reducing financial risks and streamlining billing processes. Hard-working Supervisor with exceptional experience leading teams, delivering results and exceeding expectations. Creative and motivated leader adept at utilizing exceptional design and planning strengths to accomplish complex projects. Skilled in teaching new concepts and best practice strategies. Thorough Examiner with years of experience in the examiner and claims adjustment field. Strong knowledge of resolution procedures and claim settlement. Experienced handling irate and problematic customers. Organized and professional in stressful situations.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Redetermination Claims Examiner
Noridian
08.2024 - Current
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
- Identified fraudulent activities by analyzing patterns, trends, and discrepancies in medical claims data.
- Paid or denied medical claims based upon established claims processing criteria.
- Mitigated fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
Supervisor
MPS X-Ray LLC
01.2001 - 07.2024
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
- Achieved results by working with staff to meet established targets.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Acted as a valuable resource within the organization for training new hires in accounting department on company-specific procedures, systems usage, and best practices; ensuring they became productive contributors quickly.
- Enhanced accuracy of financial reports by diligently reviewing and reconciling statements, identifying discrepancies, and making necessary adjustments.
- Assisted in timely completion of audits by compiling relevant documentation and effectively communicating with auditors throughout the process.
- Reduced financial risks by identifying discrepancies and ensuring proper documentation within the auditing process.
Education
High School Diploma -
South Hills
West Covina, CA06.2023
Skills
- Claims Processing
- Verbal Communication
- Team Leadership
- Denied claims identification
- Insurance policy coverage knowledge
- HIPAA Compliance
- Customer service experience
- Insurance Verification
- Billing processes proficiency
- Delinquent accounts monitoring
- Employee Development
- Operations Management
Certification
• SMAW Certification - Rite Hite- 2019
Industrial Electrician Technology Certificate- Chaffey College 2017
Additional Information
Proficient with Microsoft Excel, Teams, Power point, and Adobe.
Timeline
Redetermination Claims Examiner
Noridian
08.2024 - Current
Supervisor
MPS X-Ray LLC
01.2001 - 07.2024
High School Diploma -
South Hills