Resourceful Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing multiple projects and developing innovative solutions.
Hi, I’m
Carina Martinez
Summary
Overview
8
years of professional experience
1
year of post-secondary education
1
Language
Work History
TotalMed
HIM Specialist
11.2023 - Current
Job overview
- Responsible for accurately and timely indexing medical documents.
- Indexed all medical record documents to the appropriate patient medical record and visit.
- Ensured that each document is correctly assigned the appropriate document name and 100% of the medical record pages are processed/captured accurately.
- Located and entered missing data.
- Ensures all images are labeled with appropriate patient information
- Followed ROI department policies, procedures, and processes for prepping, scanning, indexing, and quality checking.
- Reviewed, evaluated and indexed patient records including but not limited to chart notes, orders/prescriptions, demographic and insurance info and other supporting documentation.
- Enhanced patient data accuracy by diligently reviewing and validating medical records.
- Continuously updated professional expertise through participation in conferences, workshops, webinars or self-study, ensuring the application of current best practices in HIM.
- Maintained HIPAA compliance with strict adherence to confidentiality guidelines for all patient information.
- Ensured timely processing of medical records for optimal patient care and facility efficiency.
- Conducted regular audits to ensure the quality and completeness of medical records, mitigating potential risks associated with inaccurate documentation.
Moda Health
Health Navigator
05.2021 - 10.2023
Job overview
- Assisted medical providers with Initializing, processing and resolving concerns/ inquiries regarding medical claims, prior authorization , COB, TPL, eligibility and benefit verification
- Handle inquiries received via phone, email, voicemail and/or online chat
- Completed detailed research and follow-up as needed
- Repeatedly analyzed situations and communicated effectively in a fast-paced environment
- Used multiple resources simultaneously to research provider issues
- These included Facets, Benefit Tracker, Content Manager, eviCore portal, Navitus, CoverMyMeds, Moda 360 Navigator Console and other internal and external websites
- Applied mathematical skills to determine correct benefit and claim information
- Reviewed, updated and become familiar with new and revised benefit information
- Built and maintained proficiency in claim processing procedures to determine whether a claim was processed or adjusted correctly
- Adjusted claims when required due to processing or configuration errors or new information
- Addressed and explained medical complaints, appeals, and grievances
- Review of medical records for appropriate ICD-9, ICD-10, HCPCS codes
- Adherence to the Health Insurance Portability and Accountability Act (HIPAA).
Lee Hecht Harrison (Adecco)
Claims Specialist
10.2018 - 05.2021
Job overview
- Reviewed and processed medical/vision claims accurately and thoroughly according to the benefits and eligibility guidelines
- Payed, pended, or denied based on established claims processing criteria
- Verified accuracy of claim data and correction of any errors
- Verified insurance coverage and authorizations
- Accurately maintained the authorization records
- Constant and effective communication with providers.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
Grifols
Phlebotomist
11.2015 - 10.2018
Job overview
- Used electronic medical software (EMR) to conduct patient intakes and send correspondence
- Screened prospective donors by conducting interviews, obtaining medical histories and measuring vital signs
- Upheld donor confidentiality throughout intake and collection process
- Obtained variety of blood samples through venipuncture or capillary puncture using syringes, butterfly needles and straight needles
- Strictly followed HIPAA Privacy and Security Regulations
- Kept lab logs, reference materials and other important data up to date.
- Improved patient comfort by efficiently drawing blood samples using various techniques such as venipuncture and capillary puncture.
- Maintained a high level of accuracy in labeling and tracking specimens, ensuring proper testing and timely results.
- Excelled in high-pressure situations, maintaining composure and professionalism during peak hours and emergency scenarios.
- Used personal protective equipment correctly to protect coworkers and patients.
- Completed proper sanitation and cleaning of equipment and work areas between patients.
- Adhered to HIPAA standards and maintained patient confidentiality in all interactions.
Education
Texas Tech University Health Sciences CenterLubbock, TX
Bachelor of Science in Healthcare Management
08.2023 - Current
University Overview
Skills
Customer Relations
Bilingual
Microsoft Office Suite Expertise
Claims Processing
Medical Terminology
Medical Terminology
Insurance Verification
Data Entry and Analysis
Quality Assurance
CPT Coding
EMR Systems
Timeline
HIM Specialist
TotalMed
11.2023 - Current
Texas Tech University Health Sciences Center
Bachelor of Science in Healthcare Management
08.2023 - Current
Health Navigator
Moda Health
05.2021 - 10.2023
Claims Specialist
Lee Hecht Harrison (Adecco)
10.2018 - 05.2021
Phlebotomist
Grifols
11.2015 - 10.2018