Brenda Rich
Pomona,CA
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. Well-qualified leader offering demonstrated skill and success in managing internal accounting processes, improving controls and strengthening systems for optimal performance. Gifted in building and leading solid teams to handle high-volume operations with consistency, accuracy.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Claims Processor One
IEHP
Rancho Cucamonga, CA
05.2015 - Current
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Checked documentation for accuracy and validity on updated systems.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
ERRVU Configurtion
Medical Professional Staffing
Rancho Cucamonga, CA
10.2014 - 05.2015
- Knowledge of CPT4, IDC9-10, HCPCS, double boarded providers Professional and facility claims. Department goal was to process 780 rejected claims. Job duty was to pick the correct provider, match and verify members eligibility.
- Surpassed daily expectations.
- Contributed ideas and suggestions in team meetings and delivered updates on deadlines, designs and enhancements.
- Performed software testing to uncover bugs and troubleshoot hard coding payment for auto-adjudication issues prior to application launch.
Member Services Call Center
Kaiser Permanente
Corona, CA
05.2014 - 09.2014
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Educated customers on company systems KP.ORG, form completion and access to services.
- Learned and maintained in-depth understanding Kaiser Foundation's product information, providing knowledgeable responses to diverse questions. award
- Medicare 5 star Trained, Perfect Attendance, Advocate for member with filing a grievance.
Member Service Call Center Temp
Modis
Corona, CA
02.2014 - 05.2014
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- 5 star Medicare trained, Perfect Attendance,
- Helped member with policy payments, disputes, dis-enrollments, re-enrollment, Obama care questions. call scheduling, pharmacy and file grievances.
Medical Claims Follow up Lead
Medical Professionals Progressive Mgmt Systems
Covina, CA
09.2013 - 01.2014
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Paid or denied underpaid and overpaid medical claims based upon established claims processing criteria.
- Responded to correspondence from insurance companies.
- Evaluated accuracy and quality of data entered into agency management system.
- Researched claims and incident information to deliver solutions and resolve problems.
Director of Operations
Medical Reimbursement Express
Temecula, CA
02.2012 - 01.2014
- Oversaw day-to-day production activities in accordance with business objectives.
- Defined, implemented and revised operational policies and guidelines.
- Monitored office workflow and administrative processes to keep operations running smoothly.
- Directed management meetings to enhance collaboration and maintain culture based on trust and group problem-solving.
- Recruited, hired and trained initial personnel, working to establish key internal functions and outline scope of positions for new organization.
Claims Manager
Integrity Reimbursement Inc
Ontario, CA
02.2008 - 12.2011
- Handled Commercial, Government, Worker's Comp, Third Party liability. Took escalated calls from patients to defuse he situation when needed.
- Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Documented and communicated timely claims information while supporting accurate outcomes.
Customer Service Representative III
Clinical Practice Management
Orange, CA
02.2006 - 02.2008
- Maintained customer satisfaction with forward-thinking strategies focused on addressing patient's needs and resolving concerns.
- Answered patient calls promptly to avoid on-hold wait times.
- Filed phone and formal paper appeals for all insurance carriers in state and out of state.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Provided primary customer support to internal staff and external office managers. Handled high priority clinics with over 10,000 visits a month.
Customer Service Representative Team Lead
BMS
Upland, CA
10.2003 - 05.2006
- Handled day-to-day customer contact via phones, faxes and emails.
- Provided support to my team, 6 A/R reps, 2 call reps and 1 payment poster. High volume priority clients with 12,000 visits.
- Explained medical benefits, deductibles, co-ins, copays,non covered benefits to the patients.
- Maintained financial accounts by processing customer adjustments.
- Opened and maintained patient balance accounts per 30>60>90>120>180 by recording account information for collections
Medical Claims Supervisor
Medical Data Exchange
Long Beach, CA
10.1987 - 10.2003
- Billing and Follow up Supervisor for 16 years, audit and file appeals. Supervised the AB75 program and contracted out to the county of Riverside for 6 months. Mt with directors of hospitals to go over A/R, procedures and any concerns.
- knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Responded to correspondence from insurance companies.
- Generated, posted and attached information to claim files.
- Manually posted payments and applied deductible nd co-ins for Medi-Medi claims
- Coded UB92 claims for Cedars-Sinai, Stanford etc. Broke down charges from IZ for billing. Cycle billing for City of Hope.
- Trained 12 customer service reps.
Education
No Degree -
EDS Training Seminars
Pasadena, CANo Degree -
ACS Training Seminars 2012
Ontario, CANo Degree - Medical Terminology
Allied Medical Schools
Laguna Niguel, CAHigh School Diploma -
Benjamin Franklin High School
Los Angeles, CA06.1984
Skills
- Medical Billing and Coding
- Account Follow-Up
- Accuracy Verification
- Data Verification
- Accounts Payable and Accounts Receivable
- Business Operations
- Knowledge of HIPAA Regulations
- Tracking Spreadsheets
- Reviewing Patient Information
- Call Center Customer Service
- Client Correspondence
- Eligibility Determinations
- Health Insurance Industry Knowledge
- Managing Operations and Efficiency
- Issue and Conflict Resolution
Accomplishments
Two letters of outstanding Customer service from Vice President Rob Munsun Kaiser Permanent.
Certification
Kaiser Permanente 5 Star Medicare trained.
Perfect Attendance. Graduation From 12 week Kaiser MSCC Training
Timeline
Claims Processor One
IEHP
05.2015 - Current
ERRVU Configurtion
Medical Professional Staffing
10.2014 - 05.2015
Member Services Call Center
Kaiser Permanente
05.2014 - 09.2014
Member Service Call Center Temp
Modis
02.2014 - 05.2014
Medical Claims Follow up Lead
Medical Professionals Progressive Mgmt Systems
09.2013 - 01.2014
Director of Operations
Medical Reimbursement Express
02.2012 - 01.2014
Claims Manager
Integrity Reimbursement Inc
02.2008 - 12.2011
Customer Service Representative III
Clinical Practice Management
02.2006 - 02.2008
Customer Service Representative Team Lead
BMS
10.2003 - 05.2006
Medical Claims Supervisor
Medical Data Exchange
10.1987 - 10.2003
No Degree -
EDS Training Seminars
No Degree -
ACS Training Seminars 2012
No Degree - Medical Terminology
Allied Medical Schools
High School Diploma -
Benjamin Franklin High School
Similar Profiles
Jessica JaimeJessica Jaime
Referral / Behavioral Health Coordinator at IEHPReferral / Behavioral Health Coordinator at IEHP
Thelma MartinezThelma Martinez
Member Service Representative at IEHPMember Service Representative at IEHP
Leticia RubalcabaLeticia Rubalcaba
Member Service Representative -Medicare at IEHPMember Service Representative -Medicare at IEHP
Cindy NguyenCindy Nguyen
Transition of Care Clinical Pharmacist at IEHPTransition of Care Clinical Pharmacist at IEHP
Rylie GriffinRylie Griffin
Barista Shift Supervisor at StarbucksBarista Shift Supervisor at Starbucks