Audra Rodriguez
Austin,TX
Summary
Highly-motivated with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
10
10
years of professional experience
Work History
Claims Examiner II
Texas Department of Insurance (Division of Workerm
Austin, TX
08.2023 - Current
- Reviewed medical records and documents to determine coverage eligibility of claims for insurance benefits.
- Analyzing evidence and applications for compensable medical services and treatments related to a diverse array of occupational illnesses.
- Investigated discrepancies in claims and resolved issues with customers via telephone or written correspondence.
- Processed and denied claims according to established procedures while ensuring compliance with applicable laws and regulations.
- Developed a detailed understanding of the company's policies and procedures related to claim processing.
- Provided guidance to other staff members regarding claim processing rules and regulations.
- Collaborated with internal departments such as Underwriting, Provider Relations, Medical Management, Quality Assurance., as needed.
- Maintained up-to-date knowledge about changes in healthcare reform legislation affecting provider reimbursements.
- Initiated contact with providers to obtain additional information needed for accurate adjudication of claims.
- Conducted audits of claim files to ensure adherence to departmental standards.
- Participated in quality assurance activities such as peer reviews and audits.
- Independently completes assignments daily.
- Tracked progress of pending cases through manual follow-up or automated systems.
- Managed workloads efficiently by prioritizing tasks based on urgency or importance.
- Completed required investigations on referred files within established timeframes.
Phlebotomist
BioReference Laboratories
Austin, TX
03.2015 - 11.2020
- Performed venipuncture and other blood collection procedures according to established standards.
- Consulted with physician and other medical professionals utilizing proficient medical terminology.
- Assisted in the preparation of laboratory specimens for analysis and testing.
- Maintained a clean, safe, and organized work environment.
- Verified patient information prior to specimen collection.
- Collected specimens from adult patients.
- Followed all safety protocols when handling hazardous materials.
- Processed samples accurately and efficiently.
- Monitored inventory levels of supplies used in phlebotomy services.
- Documented patient information into electronic medical records system.
- Consulted with patients regarding invoicing, records, and billing of services provided.
- Prepared specimens for transport to external laboratories.
- Adhered to HIPAA guidelines regarding patient privacy.
- Provided excellent customer service while interacting with patients.
- Responded quickly and effectively to emergency situations.
- Maintained accurate records of collected specimens and test results.
- Delivered quality patient care by completing accurate and timely collection and transport of clinical specimens according to established procedures.
- Centrifuged blood specimens in test tubes to separate cells and sediment from blood serum.
Supervisor/Trainer/Donor Floor & Receptionist
DCI Biologicals Inc.
Austin, TX
08.2014 - 02.2015
- Directed and supervised team of 15 employees in daily operations.
- Implemented operational policies and procedures to ensure efficiency and accuracy of workflows.
- Resolved customer complaints in a timely manner while ensuring customer satisfaction.
- Ensured compliance with workplace safety regulations by training staff members.
- Provided guidance and direction to subordinates regarding job duties and responsibilities.
- Completed records inventory and file plans.
Education
Associate of Arts - General Studies
Austin Community College
Austin, TX05-2023
Certificate - Medical Assisting
Southern Careers Institute Inc
Austin, TX01-2013
Skills
- Written Communication
- Claims Processing
- Data Verification
- Team Collaboration
- File and Record Management
- Claims Evaluation
- Oral Communication
- Critical Thinking
- Reliability
- Organizational Skills
- Adaptability and Flexibility
- MS Office
- Problem Solving
- Task Prioritization
Timeline
Claims Examiner II
Texas Department of Insurance (Division of Workerm
08.2023 - Current
Phlebotomist
BioReference Laboratories
03.2015 - 11.2020
Supervisor/Trainer/Donor Floor & Receptionist
DCI Biologicals Inc.
08.2014 - 02.2015
Associate of Arts - General Studies
Austin Community College
Certificate - Medical Assisting
Southern Careers Institute Inc