Bianca Gonzalez
El Paso,TX
Summary
Detail-oriented and highly organized Medical and Hospital Claims Processor with experience reviewing, verifying, and processing claims while ensuring accuracy and compliance with insurance guidelines and healthcare regulations. Skilled in claims adjudication, eligibility verification, denial resolution, medical terminology, and maintaining accurate patient and billing records. Strong ability to manage high claim volumes, investigate discrepancies, and communicate effectively to support timely claim resolution and reimbursement.
Overview
14
14
years of professional experience
Work History
Claims Processor
Sagility Healthcare
El Paso, TX
04.2022 - Current
- Processed and reviewed medical and hospital claim for accuracy, completeness, and compliance with payer guidelines.
- Verified patient eligibility, benefits and coverage prior to claim submission.
- Reviewed and interpreted medical records, billing information, and Explanation of Benefits (EOBs)
- Verified CPT, ICD-10 and HCPCS codes for proper reimbursement.
- Evaluated and approved or denied claims based on established authorization criteria.
Claims Examiner
BroadPath Healthcare
El Paso, TX
06.2021 - 05.2026
- Processed medical claims using advanced claims management systems to ensure accuracy and compliance.
- Reviewed and verified insurance eligibility, ensuring timely processing of claims within regulatory guidelines.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
Team Lead / Quality Analyst
HGS - Hinduja Global Solutions
El Paso, TX
01.2017 - 06.2021
- Analyzed claim trends to identify areas for improvement and implement strategic solutions.
- Led claims processing team, ensuring adherence to company policies and regulatory requirements.
- Conducted regular performance reviews, providing constructive feedback to enhance team productivity.
- Managed the daily operations of the claims team, ensuring adherence to guidelines and deadlines.
- Reduced claim errors by providing comprehensive training to team members on company policies and procedures.
- Created and revised procedures, checklists and job aids to reduce errors.
Medical Assistant
Family & Occupational Health Center
El Paso, TX
08.2015 - 01.2017
- Assisted healthcare providers with patient examinations and documentation of medical histories.
- Administered injections and performed basic laboratory tests to support clinical operations.
- Educated patients on treatment plans and medication usage, enhancing patient understanding and compliance.
- Maintained accurate medical records in electronic health record (EHR) systems, ensuring data integrity.
Manager
Five Guys
El Paso, TX
08.2012 - 08.2015
- Trained, coached and mentored staff to ensure smooth adoption.
- Met all customer guidelines including service levels, handle time and productivity.
- Solved unresolved customer issues and managed workflow to exceed quality service goals.
- Accurate cash handling and proper store closing.
Education
Assosciate Degree - Medical Assistant
Vantage College
El Paso, TX09-2016
Skills
- Medical and Hospital Claims Processor
- Claims Adjudication
- CPT / ICD-10 / HCPCS Coding Knowledge
- Data Entry
- Medicare and Medicaid Claims
- Quality Assurance
- Explanation of Benefits (EOB) Review
- Time Management
- Multitasking proficiency
Timeline
Claims Processor
Sagility Healthcare
04.2022 - Current
Claims Examiner
BroadPath Healthcare
06.2021 - 05.2026
Team Lead / Quality Analyst
HGS - Hinduja Global Solutions
01.2017 - 06.2021
Medical Assistant
Family & Occupational Health Center
08.2015 - 01.2017
Manager
Five Guys
08.2012 - 08.2015
Assosciate Degree - Medical Assistant
Vantage College