Ashley Garcia
San Antonio,TX
Summary
Approachable Medical Claims Processor proudly offering many years' experience in handling multiple administrative responsibilities in fast-paced office environments. Hardworking professional interacting with providers to discuss claim status or denials. Attentive to details and highly collaborative.
Overview
12
12
years of professional experience
Work History
Medical Claims Processor
United Healthcare, UHG
San Antonio, Texas, TX
07.2023 - Current
- Processed UnitedHealthcare medical claims using claims adjudication systems.
- Reviewed claim details for eligibility, benefits, and coding accuracy.
- Interpreted plan documents and policy guidelines for claim decisions.
- Resolved claim issues through provider and member account research.
- Escalated complex UnitedHealthcare claims for further review and resolution.
- Applied HIPAA standards during sensitive claim data handling.
- Processed a high volume of claims on a daily basis using established time frames.
- Ensured compliance with insurance company policies and procedures related to the processing of claims.
- Verified accuracy of provider data entered into the system including tax ID numbers, NPI numbers, address changes.
- Submitted electronic claims to various clearinghouses for processing. through various clearinghouses.
- Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
- Reviewed claims for accuracy before submitting for billing.
- Calculated payments due based on allowed charges compared to billed charges according to contract terms with payers, insurers, third parties.
Advertising support specialist
TaskUs
San Antonio, Texas, TX
06.2021 - 05.2023
- Advised business owners on budget optimization, audience targeting, and ad format selection to enhance Return on Ad Spend.
- Helping small business owners set up their ad accounts, how to maximize their potential viewership and understand pixel tracking.
- Assisted small business owners in setting up ad accounts, maximizing viewership potential, and understanding pixel tracking.
Leasing Consultant
FMREI Management
San Antonio , TX
01.2019 - 01.2021
- Marketed diverse properties to prospective clients and consistently exceeded target closing rates.
- Conducted property showings to highlight features, answer questions and redirect concerns to close contracts.
- Inspected properties before and after new tenant move-ins to schedule maintenance, cleaners and other services.
- Oversaw monthly collections and built positive relationships with tenants to ensure high payment rates.
- Cultivated long-term relationships with property owners and professionals to provide exceptional leasing consultation.
- Collected rent payments from tenants to ensure timely revenue flow. and tracked resident payments and information in computer system.
- Achieved high approval rating through exceptional service. and maintained customer loyalty with top-notch service.
- Resolved conflicts between tenants regarding noise, encroachments and parking.
- Maintained accurate, detailed records compliant with state, local and federal housing requirements.
- Helped clients find leases to suit needs such as handicapped access, pet-friendly locations and one-story configurations.
- Verified tenant income and documentation to approve lease applications. and other information before accepting lease applications.
Viewer Experience Advocate
Hulu
San Antonio, TX
03.2018 - 01.2019
- Answered average of 75 calls, emails and faxes per day, addressing customer inquiries, solving problems and providing product information.
- Identified and implemented process improvements to enhance service delivery.
- Effectively communicated with customers about account changes, new products or services and potential upgrades.
- Demonstrated high energy and professionalism while engaging with clients and colleagues.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Improved overall efficiency by anticipating needs and providing outstanding support.
- Sought ways to improve processes and services provided.
- Guided customers through billing, payment processing, and support policies to ensure clarity and understanding.
Customer Service Specialist
Qualfon
San Antonio, TX
02.2017 - 02.2018
- Handled 70+ calls per shift to sign up new customers, retrieve customer data, present relevant product information, and cancel services.
- Collected customer feedback and implemented process changes, exceeding customer satisfaction goals.
- Collected payment information from customers to process orders accurately. and other pertinent information such as addresses and phone numbers to place orders.
- Collected customer feedback and made process changes to exceed customer satisfaction goals.
- Surpassed performance goals by approaching interactions with resourcefulness, organization and customer-centric solutions.
- Executed opening and closing functions to ensure smooth daily operations. to meet operational needs underpinning strong customer service.
- Presented product features during customer interactions and benefits to assist customers in making informed purchasing decisions. and benefits to help guide purchasing decisions.
- Managed over 70 customer calls per shift to support account sign-ups and service inquiries. per shift signing up new customers, retrieving customer data, presenting relevant product information and cancelling services.
- Described product highlights and benefits to help guide purchasing decisions.
- Increased efficiency and team productivity by promoting operational best practices.
- Achieved high satisfaction rating through proactive resolution of customer issues in one call.
- Complied with company policies and procedures by encouraging positive and effective work environment among all employees.
Home Health Aide
Girling Home Health
San Antonio, TX
03.2015 - 01.2017
- Offered patients and families emotional support and instruction in preparing healthy meals, independent living and adaptation to disability or illness.
- Assisted patients with dressing, grooming and feeding needs, helping to overcome and adapt to mobility restrictions.
- Provided mobility assistance such as walking and regular exercising.
- Encouraged patient participation in safe physical activity, boosting mood and enhancing overall wellness.
- Coordinated daily medication schedules and administration, addressing symptoms and improving quality of life.
- Administered medication according to physician instructions.
- Developed rapport to create safe and trusting environment for care..
- Developed rapport to create a safe and trusting environment for care.
- Coordinated transportation for clients to medical appointments, ensuring timely arrivals.
- Increased medication and medical terminology knowledge through research and continuing education.
- Oversaw daily activities for patients to ensure safety and engagement. and provided assistance to staff.
Retail Sales Assistant
Burke's Outlet
San Antonio, TX
09.2014 - 01.2015
- Collaborated with shift manager to resolve customer concerns and enhance service quality.
- Assisted customers with locating and choosing merchandise in store departments.
- Provided accurate information about promotions, customer programs and products, helping drive high customer retention.
- Refunded payments for returned items, processed exchanges and offered store credit to achieve customer satisfaction.
- Sourced hard-to-find merchandise across various locations to meet customer demands.
- Supported loss prevention goals by monitoring shopper behavior.
- Opened and closed store independently and prepared nightly bank drop for manager.
Education
Highschool Diploma -
San Antonio Technology Academy
San Antonio, TexasSome College (No Degree) -
San Antonio College
San Antonio, TXSkills
- Account research
- Claims adjudication
- Claims review
- Claims assessment
- Medical billing
- Healthcare billing
- Benefit verification
- ICD-10-cM coding
- ICD codes
- Claims processing software
- Electronic claims processing
- HIPAA compliance
- Policy interpretation
- Insurance claims management
- Insurance operations
- Data verification
- Provider data management
- Provider credentialing
- Provider interactions
- Provider relationship management
- Payment processing
- Account research
- Attention to detail
- Problem solving
- Analytical thinking
- Time management
- Healthcare compliance
- Continuous learning mindset
- Ethics and professionalism
- Telephone etiquette
- Provider relationship management
Timeline
Medical Claims Processor
United Healthcare, UHG
07.2023 - Current
Advertising support specialist
TaskUs
06.2021 - 05.2023
Leasing Consultant
FMREI Management
01.2019 - 01.2021
Viewer Experience Advocate
Hulu
03.2018 - 01.2019
Customer Service Specialist
Qualfon
02.2017 - 02.2018
Home Health Aide
Girling Home Health
03.2015 - 01.2017
Retail Sales Assistant
Burke's Outlet
09.2014 - 01.2015
Highschool Diploma -
San Antonio Technology Academy
Some College (No Degree) -
San Antonio College