Angelica Montez
Sacramento,CA
Summary
Dynamic professional with a proven track record at Delta Dental, excelling in appeals management and customer service. Adept at streamlining processes and enhancing member satisfaction through meticulous claim analysis and effective communication. Skilled in medical billing and compliance, I thrive in collaborative environments, ensuring timely resolutions and fostering positive relationships.
Overview
5
5
years of professional experience
Work History
Analyst - Badge Technician
Softworld
UC Davis Health
12.2025 - Current
- Collaborated with cross-functional teams to troubleshoot access control issues, resulting in a significant reduction in badge-related incidents.
- Collecting necessary documentation from new hires to create their employee badges.
- Taking employee photos for their badges.
- Printing employee badges using dedicated equipment.
- Entering employee information into the badge system to ensure accurate access control.
- Handling requests for replacement badges due to loss, damage, or termination.
- Verifying employee eligibility for badges and maintaining compliance.
- Generating reports on badge usage and activity.
- Answering questions and assisting employees with badge-related issues.
- Basic understanding of computer systems and badge printing equipment.
- Ensuring accuracy in data entry and badge information.
- Ability to interact with employees in a professional manner.
- Efficiently inputting employee information into the system.
- Understanding security protocols and compliance requirements.
- At Softworld, Inc., we pride ourselves on being one of the nation's top staffing companies, consistently delivering the highest-caliber technical resources faster than our competitors. Our commitment to excellence is reflected in our deep industry knowledge, innovative hiring strategies, and unwavering dedication to our clients and consultants.
Case Manager - Medicaid Department
Artech LLC - Kaiser Permanente
04.2024 - 12.2025
- Manages the resolution of Grievance and Appeals cases by thoroughly investigating incidents, communicating with members and their advocates both verbally and in writing, and ensuring all interactions are handled with professionalism and empathy.
- Reviews cases to confirm completeness and accuracy of documentation, consistently completing work assignments ahead of deadlines.
- Provides expert recommendations and solves complex problems independently, escalating high-priority issues or risks as appropriate.
- Monitors progress and results, supporting the development of strategic work plans to align with business priorities and critical timelines.
- Proactively monitors and analyzes the case tracking database to identify complex, specialty, or flagged cases across all lines of business that require advanced resolutions.
- Regularly reporting trends to management related to the processing of complex or high-risk incident cases.
- Ensures compliance in all case management activities with both internal protocols and external regulatory requirements, performing duties with a high degree of autonomy and accuracy.
- Verifying billing information in EPIC software application.
Escalation Coordinator, Grievance and Appeal
Delta Dental
Rancho Cordova
05.2023 - 12.2024
- Resolve appeals, grievances for better member satisfaction, ensuring compliance.
- Collaborate cross-departmentally to tackle complex customer issues efficiently.
- Document, analyze cases for timely resolutions, enhancing service quality.
- Apply dental expertise to streamline claims, achieving measurable improvements.
- Managed complex appeals and grievances, analyzing dental claims and procedures to provide thorough resolutions and improve departmental efficiency.
- Guided customers through intricate inter-departmental situations, offering strong support and clear communication to ensure satisfactory outcomes.
- Streamlined grievance case documentation and research processes, leading to faster resolutions and enhanced member satisfaction.
- Fostered effective partnerships across departments, leveraging dental expertise to address complex inquiries and expedite issue resolution.
- Applied meticulous attention to detail in analyzing claims, ensuring accurate processing and compliance with dental procedures and guidelines.
- Optimized grievance resolution processes, leading to faster case closures and enhanced member satisfaction across dental claim procedures.
- Streamlined appeals documentation, significantly reducing processing time and improving overall departmental efficiency in claim management.
- Guided customers through intricate dental procedures, providing clear communication and strong support to achieve satisfactory outcomes.
- Applied meticulous analysis to dental claims, ensuring accurate processing and strict adherence to industry guidelines and procedures.
- Analyze complex dental claims, ensuring accurate processing and compliance with industry guidelines, leading to improved resolution times.
- Foster cross-departmental partnerships to address intricate customer inquiries, expediting issue resolution and enhancing overall service quality.
- Streamline appeals and grievance processes, significantly reducing case closure times and boosting member satisfaction in dental claim procedures.
Customer Service Representative II
Delta Dental of CA
05.2021 - 05.2023
- Analyzed inquiries, ensuring timely and accurate resolutions.
- Documented system issues, enhancing operational efficiency.
- Completed forms precisely, streamlining departmental processes.
- Maintained high response rates, improving customer satisfaction.
- Supported cross-departmental tasks, fostering team collaboration.
- Analyzed complex insurance policies to provide accurate benefit information, enhancing customer understanding and reducing claim disputes.
- Streamlined inquiry response process, significantly reducing turnaround times and improving customer satisfaction rates.
- Partnered with cross-functional teams to resolve system discrepancies, ensuring data integrity and operational efficiency.
- Meticulously documented and routed inquiries, maintaining high accuracy in form completion and departmental communication.
- Implemented contact tracking system to proactively follow up on open calls, ensuring timely resolution and enhancing customer experience.
- Optimized inquiry resolution process, reducing turnaround times and enhancing customer satisfaction through data-driven improvements.
Education
Associate Degree - Medical Billing
Herzing University
Online 12-2019
Skills
- Appeals management
- Claim processing
- Sufficient typing skills for timely and accurate input and production
- Medical coding
- Knowledge of practices and protocols related to medical office procedures, ie medical terminology, appointments, medical records, insurance verification, cashiering, billing, etc
- Maintaining logs and files of information in alphabetical, chronological, and/or numerical order
- Knowledge of all pertinent laws, regulations, and guidelines governing medical records, confidentiality, and privacy, including HIPAA
- CPT coding
- Customer service
- Knowledge of health care insurance systems, including Medi-Cal, Medicare, HMO, PPO, fee-for-service, county-funded coverage, and workers' compensation
- Sufficient to properly obtain and track authorizations, appoint patients, make referrals for consults, diagnostics, and ancillary services
- Completing and submitting billing documentation
- Dental claims processing
- Dental terminology
- Escalation coordinator
- Grievance and appeals management
- Grievance resolution
- HCPCS coding
- Health service protocols
- ICD-10
- ICD-9
- Interpersonal communication
- Medical billing
- Organizational skills
- Patient information analysis
- Provider service
- Time management
- Knowledge of the electronic health record (EPIC) software application
Recognition
Constantly praised by members stating that I provide excellent customer service
References
References available upon request.
Timeline
Analyst - Badge Technician
Softworld
12.2025 - Current
Case Manager - Medicaid Department
Artech LLC - Kaiser Permanente
04.2024 - 12.2025
Escalation Coordinator, Grievance and Appeal
Delta Dental
05.2023 - 12.2024
Customer Service Representative II
Delta Dental of CA
05.2021 - 05.2023
Associate Degree - Medical Billing
Herzing University