Barbara Nitaya Taylor
Lubbock,TX
Summary
I am a committed and motivated professional with exceptional relationship building and decision-making skills. Proven ability to manage high volumes of claims efficiently while maintaining high accuracy. Utilizes analytical skills and attention to detail to ensure accurate and timely claim resolutions.
Overview
29
29
years of professional experience
Work History
Senior Claims Processor
Vision Service Plan
Sacramento, CA
12.2022 - Current
- Managed workload and priorities to meet claims processing deadlines.
- Managed high-volume caseloads, ensuring timely and accurate completion of claims processing tasks.
- Reduced errors in claims processing through quality control measures.
- Mentored coworkers on best practices for claims processing and enhancing their knowledge and skills for improved job performance.
- Analyzed complex claims to ensure accuracy and compliance.
- Followed up with providers on unresolved issues.
- Respond to providers inquiries, providing detailed explanations of benefits and claims submission.
Claims Processor
Vision Service Plan
10.2016 - 12.2022
- Effectively and efficiently process claims ranging from routine to complex situations
- Ensure accurate payment, data integrity and standards or compliance obligations
- OON Workaround
Customer Service Representative
Vision Service Plan
07.2014 - 10.2016
- Effectively and efficiently respond to telephone inquiries ranging from routine to complex situations from members, doctors and clients.
- In-depth knowledge of plans, products and services, policies & procedures for claim payment & billing errors.
- Resolve member and doctor complaints and grievances.
- Accurate completion of necessary documentation, letters and forms processing.
- Effectively educate and influence members and prospective members on the value and benefit that VSP offers.
- World Class Certified – 2014 & 2015
Senior Office Assistance
Sacramento County
07.2000 - 08.2005
- Provided support for eight or more Case Managers and the Department Head.
- Assisted new client set-up and intake interviews for Children’s Mental Health services.
- Communicated daily with school officials, community agencies and other counties on referral services.
- Initial contact for all regarding Children’s Mental Health services.
- Managed sensitive information with discretion while following strict confidentiality protocols as required within the company''s guidelines.
- .Prioritized tasks effectively under tight deadlines while ensuring accuracy and attention to detail in all deliverables.
- Increased social worker satisfaction by promptly addressing inquiries and resolving issues via phone, email, or in-person interactions
Legal Transcriber
Sacramento County
11.1997 - 07.2000
- Transcribed Court reports and correspondence from dictation accurately, ensuring clarity and compliance with legal standards.
- Assisted in the training of over 50 Social Workers in preparation of Court and office documents.
- Maintained an excellent rapport with Social Workers to ensure deadlines were met and reports were completed in a timely manner.
- Reviewed reports of Social Workers and staff for quality assurance ensuring guidelines are met and returned for correction.
- Participated on Action Improvement Committee for quality assurance
- Expedited legal documents with rapid turnaround times for urgent transcription requests from social workers.
- Provided exceptional client service by responding promptly to inquiries regarding transcript status or content clarification requests.
- Maintained high standards of quality control by proofreading transcripts for errors before submission to clients or attorneys.
Education
AA - Legal Administrative Assistant
Heald Business College
01-1993
Skills
- Strong communication skills
- Critical thinking
- Written communication
- Mentoring
- Claims processing
- OON/INN Adjustments, CAIRs, Medicaid/Medicare, PEC, RAT, Workarounds
- Knowledge of COB's and NCL
Timeline
Senior Claims Processor
Vision Service Plan
12.2022 - Current
Claims Processor
Vision Service Plan
10.2016 - 12.2022
Customer Service Representative
Vision Service Plan
07.2014 - 10.2016
Senior Office Assistance
Sacramento County
07.2000 - 08.2005
Legal Transcriber
Sacramento County
11.1997 - 07.2000
AA - Legal Administrative Assistant
Heald Business College