Candance ( Candy) Love
Medical
Sacramento,USA
Summary
Accomplished medical professional with over 36 years of diverse experience in the healthcare industry, specializing in medical claims processing, customer service, and office management. Expertise includes claims adjustment, dispute resolution, appointment scheduling, and workers' compensation, along with a strong background in medical billing and insurance collection. Proficient in ICD-9/ICD-10 and HCPCS coding, as well as navigating various software systems to enhance operational efficiency. Extensive experience as a dental claims auditor has further developed problem-solving skills and effective communication within high-volume environments.
Overview
36
36
years of professional experience
1
1
Certification
Work History
Senior Office Assistant
Sacramento County Department of Health Services
04.2024 - Current
- Review and research work ques for patient account for issues then correct any issues. Researching health coverage in medi-cal portal or other health coverage portals. Update patient coverage records, create patients’ coverage in system, and or term policy in the system. Once correct submit claim for payment. Receive mail sort medical payment checks, correspondence, and zero payments for weekly deposit. Code checks for deposit, record check payment on deposit logs, balance deposit logs, then copy checks and send to finance. Research patient coverage for any issue that may arise for the laboratory and submit via spreadsheet with correction to the laboratory. I create pivot tables for Vivant checks to break down the check payments and submit to other clinics for their coding and dollar amount for weekly deposit. Varies other task that are ask of me.
- Supervisor: Adam Prekegas 916-874-6304
Senior Account Clerk II
Sacramento County Department of Health Services
12.2023 - 04.2024
- Review and research patient account for issues then correct any issues. Research members health coverage update, create coverage in system, or term policy in the system. Once correct submit claim for payment. Weekly deposits of insurance payments and medical records. Code checks for payment processing and prepare batch and send to fiscal. Update payment and deposit logs.
- Supervisor: Rachal Callan 727-871-7224
Account Clerk II
Sacramento County Department of Health Services/ Apple One
07.2023 - 12.2023
- Review and research patient account for issues then correct any issues. Research members health coverage update, create coverage in system, or term policy in the system. Once correct submit claim for payment.
- Supervisor: John Dizon 916-505-8283
Claims Examiner
Kaiser Apex
03.2023 - 06.2023
- Review medical claims (hospital, workers comp, office) for coding accuracy, payment accuracy, referrals, authorization, process to pay and or adjust for correct payment.
- Supervisor Apex Shelby - 949-939-9359
Collection clerk
Optum 360/Robert Half Narghes
07.2022 - 01.2023
- Refund undefined payments to insurance companies, research, locate member of undefined payment and post payments to member account. Research and balance a daily spreadsheet to match incoming payments and debits. Post 90 code payments to unidentified account.
- CONTRACT
Advanced Claims Analyst/Member Reimbursement CA, OR, WA, AZ-Medicare Appeals Triage
Centene/ Health Net
02.2018 - 01.2022
- Processing HMO, Medicare, Marketplace, and California Exchange claims for payments and denials. Adjustments for Marketplace claims. Member reimbursement responsibilities are triage member paperwork for all required documents, coding, sending translation if needed, obtaining authorizations, keying in claims into Emdeon, process claims once transfers to Amysis then process to pay. I also work on various projects as well.
- Supervisor Thomasine Mitchell 916-754-3296 or Dawn Lawrence 916-271-0881
Claims Analyst
Health Net Commercial Service
09.2017 - 02.2018
- Processing HMO claims for payments and denials. Research member demographics and provider contracts.
- Supervisor Thomasine Mitchell 916-754-3296 or Dawn Lawrence 916-271-0881
Federal Claims Billing Specialist
Health Net/Centene Federal Services
08.2016 - 09.2017
- Processing Veterans medical claims, email disputes, data entry of member demographics, research contracts, research benefits and research provider information
- Supervisor: Dawn Lawrence 916-271-0881
Claims Billing Specialist
Health Net of California
12.2014 - 08.2016
- Processing Arizona Access (Medicaid) claims, checking and research benefit contracts, data entry, transplant cases, hospital, professional and some mental health.
- They transferred us to Federal side of business
Concierge Customer Service Rep
Blue Shield of California
04.2014 - 12.2014
- Answering customer calls for high profile employer groups. Resolve billing issue, provide member with their benefits, and help resolve prescription issues.
Customer Service Rep II
Delta Dental of CA
07.2007 - 09.2013
- Answering phones in a high call volume call center, assisting patient with knowing and understanding their benefits, claims processing, assisting dental providers with benefit details, coverage, and resolving claims issues, recognizing fraud and reporting fraud, processing and troubleshooting incoming correspondence, completing any special projects giving to me by supervisor or manager.
Customer Service Rep
Delta Dental of CA
05.2007 - 07.2007
- Answering phones in a call center, helping patient with their benefits and claims. Helping Dental providers with claims issues, eligibility and benefits.
Dental Claims Auditor
Delta Dental/Select Personnel
08.2006 - 05.2007
- Review x-rays, periodontal charting, review claims for coding, review patient information, review dental provider contract profiles, Production requirements met for claim processing.
Medical Collector/Biller
Sparkman Medical Data Process/LCL
11.2004 - 06.2006
- Collection from insurance companies for 46 different providers and specialties, include appeals, liens, and negotiation of monies. I also billed insurances On-line as well as a paper hcfa. Knowledge of ICD-9 coding, CPT Coding, Workers Comp, Medicare, and Medi-cal.Also heavy phones.
Biller
Stanford Ranch Chiropractic
07.2004 - 10.2004
- I billed PPO’S, Work Comp, HMO, Medicare, Patients and secondary for specialty. Follow up claims for underpayment or insurance companies requesting information. Post payments to invoices. Authorization, phones, scheduling.
Office Manager/Front Desk/Biller
Johnson Ranch Rehab and Therapy
02.2003 - 07.2004
- Responsibilities are preparing charts for the next day, appointment scheduling, billing specialty claims, collections, answering phones, prepare daily deposits, collect co pays, posting payments, Filing
Collector/Biller
Coram Healthcare
07.2000 - 07.2002
- I billed Medicare claims for home infusion therapy. Collecting money from secondary insurance companies. Rebilling secondary insurance companies. Problem solving with primary and secondary insurances.
Office Manager/ Patient Service
Sutter Medical Foundation
01.1995 - 01.2000
- Check in and out of patients, batching, referrals, ICD-9 and CPT coding, phones, filing, scheduling of patients, editing schedules, master scheduling, registration, Cal Osha policies, month end reports, and problem solving with employees.
Education
GED -
Cordova High
01.1989
Coding and Billing Management
San Joaquin Valley College
Diploma - undefined
Walnutwood Adult High
01.2012
Skills
- Medical Billing and Collection, Account Receivable, Patient Registration, Insurance verification, 10 KEY, Data Entry, Batching, ICD-9, ICD-10, CPT coding, Authorization, Referrals, Appeals/Grievances and many different computer programs
Certification
CA Drivers License Class: C (passenger car)
Languages
English
Full Professional
Timeline
Senior Office Assistant
Sacramento County Department of Health Services
04.2024 - Current
Senior Account Clerk II
Sacramento County Department of Health Services
12.2023 - 04.2024
Account Clerk II
Sacramento County Department of Health Services/ Apple One
07.2023 - 12.2023
Claims Examiner
Kaiser Apex
03.2023 - 06.2023
Collection clerk
Optum 360/Robert Half Narghes
07.2022 - 01.2023
Advanced Claims Analyst/Member Reimbursement CA, OR, WA, AZ-Medicare Appeals Triage
Centene/ Health Net
02.2018 - 01.2022
Claims Analyst
Health Net Commercial Service
09.2017 - 02.2018
Federal Claims Billing Specialist
Health Net/Centene Federal Services
08.2016 - 09.2017
Claims Billing Specialist
Health Net of California
12.2014 - 08.2016
Concierge Customer Service Rep
Blue Shield of California
04.2014 - 12.2014
Customer Service Rep II
Delta Dental of CA
07.2007 - 09.2013
Customer Service Rep
Delta Dental of CA
05.2007 - 07.2007
Dental Claims Auditor
Delta Dental/Select Personnel
08.2006 - 05.2007
Medical Collector/Biller
Sparkman Medical Data Process/LCL
11.2004 - 06.2006
Biller
Stanford Ranch Chiropractic
07.2004 - 10.2004
Office Manager/Front Desk/Biller
Johnson Ranch Rehab and Therapy
02.2003 - 07.2004
Collector/Biller
Coram Healthcare
07.2000 - 07.2002
Office Manager/ Patient Service
Sutter Medical Foundation
01.1995 - 01.2000
Coding and Billing Management
San Joaquin Valley College
Diploma - undefined
Walnutwood Adult High
GED -
Cordova High
Interests
My grandchildren, gardening, roller skating, football, basketball, hockey, and trip to the ocean
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