Motivated and detail-oriented professional with a strong background in nonprofit healthcare services and home modification programs under Medi-Cal and IEHP. Currently seeking a Claims Specialist position to expand expertise in healthcare claims processing, documentation, and regulatory compliance. Brings hands-on experience managing program billing, ensuring accuracy in claims submission, and collaborating with providers to support member health outcomes. Eager to grow within a dynamic healthcare environment and contribute to efficient, patient-centered claims operations
Processed medical referrals and submitted healthcare claims to payers with accuracy and adherence to payer-specific and Medi-Cal guidelines. Investigated claim discrepancies and resolved internal accounting variances to ensure financial data integrity. Managed billing workflows, including accounts payable and receivable, while maintaining compliance with healthcare reimbursement policies. Collaborated with clinical and administrative teams to align referral documentation with claims requirements and improve processing efficiency.
Partnered with Warehouse Operating Managers and cross-functional teams to align labor strategies with daily productivity goals and execution plans. Generated and analyzed multiple daily performance reports, identifying trends and recommending data-driven improvements to shift execution. Monitored outbound and inbound operations, adjusting labor allocation based on forecasted volumes exceeding 5,000 cartons per shift to optimize efficiency and throughput.
Supported the monthly close process by preparing accurate financial statements and ensuring compliance with reporting standards. Reconciled end-of-month totals and account balances to deliver timely, error-free financial insights. Analyzed and compiled financial data to generate precise general ledger entries and assist with audit preparation. Streamlined daily operations by consolidating financial data from diverse systems using Power Query. Designed and implemented Excel macros to automate repetitive tasks, significantly boosting efficiency and reducing manual workload.
Fostered strong working relationships with over 50 associates by delegating responsibilities effectively and supporting team performance to consistently exceed productivity targets. Investigated and resolved inventory discrepancies by analyzing data for items in “Odd Locations” for 3+ days, improving accuracy across LGB6’s fulfillment center records. Audited and reported thousands of unprocessable inventory items, using technology solutions to troubleshoot, track, and escalate issues for timely resolution.