Carmen V. Saldana
California
Summary
With a proven track record at HEALTHCOMP THIRD PARTY ADMINISTRATORS, I excel in medical coding and critical thinking, demonstrating exceptional problem-solving and effective communication skills. Achieved beyond set metrics, enhancing customer satisfaction and operational efficiency by leveraging expertise in claims processing and emergency response.
Overview
35
35
years of professional experience
1
1
Certification
Work History
TRIAGE INTAKE SPECIALIST -UM
HEALTHCOMP THIRD PARTY ADMINISTRATORS
08.2021 - Current
- Knowledge, and interpretation of medical codes and determination of medical necessity
- Maintain complete and detailed documentation of case information
- Strong organizational skills, compiling monthly reports
- Critical thinking skills, demonstration of analysis/judgement and sound decision
- Strong problem-solving skills
- Attention and focus to detail
- Strong Verbal, written communication skills
- Consistently achieve and surpass set metrics for current position
ELECTRONIC CLAIMS EDITOR
HEALTHCOMP THIRD PARTY ADMINISTRATORS
11.2014 - 08.2021
- Access internal EDI (Electronic Data Interchange) portal to view and correct HCFA, UB, ICD9, ICD-10, and Dental electronic claims
- Edit and correct provider and patient information on claims
- Research SPD-Summary Plan Description for relevance of claims
- Supervise, train and audit co-workers' production, and report
- Microsoft Word, Excel, Microsoft Outlook, Smartsheet, Microsoft teams
EMERGENCY MEDICAL TECHNICIAN
AMERICAN AMBULANCE
10.2005 - 06.2013
- Knowledge of BLS for providers, lifesaving skills
- Maintain timely arrival for 911 related emergencies
- Drive safely while transporting passengers and always follow all regulations
- Maintain documentation of interactions with clients
- Keep ambulance clean and restock all supplies often
- Field Training Officer - taught new trainees all duties corresponding to EMT duties
Emergency Medical Technician
Life Star Ambulance
Tulare, California
06.2005 - 10.2005
- Assure equipment is properly working and stocked, ambulance care and maintenance
- Help EMT II or EMT-P with patient's vital sign, c-spine, gurney operations, and ambulance
- Keep continual contact with dispatcher
- Obtain demographic information for hospital and billing forms
- Strictly maintain protocols
- Long distance BLS transports with patients
- Keep up with continued education classes and hours
EZLink Product Support
Aetna Inc.
03.2004 - 02.2005
- Customer Service for members, Account Representatives, Plan Sponsors, and other employees
- Log in for customers to computer systems EZLink and Navigator
- Answered eligibility inquiry's, corrected back-end system transactions
- Cleared emailed issues sent from EZLink Administrator and Supervisor
Account Management
Aetna Inc.
Las Vegas, Nevada
01.2002 - 02.2004
- Customer Service calls as Account Representatives
- Preparation of marketing materials, correspondence letters, claims issues, enrollment issues
- Customer service for brokers, plan sponsors, and members
- Ordered supplies for promotional events
- Set up convention booth for Aetna advertising
Eligibility Consultant-Supervisory Duties
Aetna Inc.
07.1999 - 01.2003
- Implemented enrollment of subscribers into the HMO/Geber and Traditional/AAS mainframe systems
- EZ enroll, answered customer service line, assisted plan sponsors, employers, and administrators to resolve insurance enrollment issues
- Assisted with irate and urgent callers while supervisor out
- Aid supervisor upon her absence
- Installed team backlog information data network
Property Claims Representative
Farmers Insurance Group of Companies
09.1997 - 07.1999
- Achieved certification for property lines adjuster
- Inspected damaged property
- Performed xactimate estimates
- Recorded statement or depositions
- Collaborated with contractors and emergency service crews to assess and repair damages
- Issued estimates and payment for damages
- Time management
- Composed Correspondence for customers
Claims Customer Service Clerical
Farmers Insurance Group of Companies
05.1990 - 09.1997
- Assisted policyholders at front counter
- Dispatched towing for damage vehicles
- Reserved rental vehicles for policyholders
- Set assignments up for auto body shops
- Checked issuance to autobody companies, rental car companies
- Confirmed and cleared insurance coverage through agents and mainframe system
- Assigned claims to auto adjusters for vehicle inspection
- Issued checks, answered questions for customers regarding their vehicle and insurance
Education
BACHELOR OF BUSINESS ADMINISTRATION - Business Administration
NATIONAL UNIVERSITY
Fresno, CA07.1997
Skills
- Medical coding
- Case documentation
- Critical thinking
- Data analysis
- Claims processing
- Report generation
- Team supervision
- Customer service
- Attention to detail
- Patient interaction
- Time management
- Problem solving
- Effective communication
- Emergency response
- Cross-cultural sensitivity
Certification
- BLS - health care provider CPR
- EKG Certificate
- Medical Terminology
- Medical Math
- ICD10
- HCPC
- CPT coding
Languages
- English, Read, Write, and Speak
- Spanish, Read, Write, and Speak
Affiliations
- I enjoy walking in different marathons.
Accomplishments
- EMT of the year
- Most case reviews/tasks completed last three months
Foreign Languages
Spanish
Full Professional
Timeline
TRIAGE INTAKE SPECIALIST -UM
HEALTHCOMP THIRD PARTY ADMINISTRATORS
08.2021 - Current
ELECTRONIC CLAIMS EDITOR
HEALTHCOMP THIRD PARTY ADMINISTRATORS
11.2014 - 08.2021
EMERGENCY MEDICAL TECHNICIAN
AMERICAN AMBULANCE
10.2005 - 06.2013
Emergency Medical Technician
Life Star Ambulance
06.2005 - 10.2005
EZLink Product Support
Aetna Inc.
03.2004 - 02.2005
Account Management
Aetna Inc.
01.2002 - 02.2004
Eligibility Consultant-Supervisory Duties
Aetna Inc.
07.1999 - 01.2003
Property Claims Representative
Farmers Insurance Group of Companies
09.1997 - 07.1999
Claims Customer Service Clerical
Farmers Insurance Group of Companies
05.1990 - 09.1997
BACHELOR OF BUSINESS ADMINISTRATION - Business Administration
NATIONAL UNIVERSITY
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