Job Search Status
Open to workDesired start date: Immediately
Open To Work
Christina Ramirez
New Braunfels
Work Preference
Summary
Experienced with managing referral and medical claim systems and client coordination. Utilizes strong communication skills to ensure accurate and timely referrals. Track record of effective problem-solving and adaptability, contributing to team success.
Overview
8
8
years of professional experience
Work History
Tricare Referral Specialist
TriWest Healthcare Alliance
01.2025 - 09.2025
- Responsible for managing and processing patient referrals within the Tricare healthcare system, ensuring eligible beneficiaries receive timely access to necessary specialty care by reviewing medical records, verifying eligibility, coordinating with providers, and authorizing referrals to appropriate specialists, all while adhering to Tricare guidelines and regulations.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout the process. Monitored referrals to foster timely completion and followed up with physicians to facilitate.
- Facilitated referral processing to improve patient access to care services and coordinated communication between healthcare providers and patients for streamlined referrals.
Medical Claims Analyst
BeneSys, Inc.
01.2024 - 08.2024
- Analyzed, reviewed, and processed complex medical claims submitted by healthcare providers for accuracy, identifying discrepancies and ensuring compliance with regulations while improving turnaround efficiency through streamlined workflows.
- Ensured compliance with insurance policies, payer guidelines, and relevant regulations, while utilizing the BeneSys claims processing system to accurately adjudicate and pay claims in a timely manner; this includes tasks like data analysis, provider communication, identifying potential errors or fraudulent activity, and resolving claim discrepancies to maintain proper financial integrity for the healthcare plan.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations. Reviewed provider coding information to report services and verify correctness.
Medical Claims Adjuster
United Healthgroup-Optum C&S
01.2018 - 07.2023
- Responsible for managing and handling Medical and Medicare claims for the government operations community and state accounts, making sure all medical and facility claims are evaluated and resolved correctly within the state’s timely guidelines. Responsible for also collecting certain types of claims based off error and warnings, challenged denials, and ensure reimbursement.
- Evaluated, analyzed, and processed complex medical claims submissions for accuracy and compliance with policies, such as identifying trends and potential fraud indicators, reviewed provider coding information to report services, verified correctness, and timely processing.
Education
Bachelor of Arts - Business Management
Strayer University
San Antonio, TX01-2027
GED -
Theodore Roosevelt H.S.
San Antonio, TXSkills
- Database Management
- Data Entry Proficiency
- Caseload Management
- HIPPA Compliance and Regulations
- EHR software
- Referral Tracking
- MS Office Expertise
- Insurance verification
- Medical terminology
- Electronic patient charts
- Insurance precertification processes
- Insurance authorizations
Timeline
Tricare Referral Specialist
TriWest Healthcare Alliance
01.2025 - 09.2025
Medical Claims Analyst
BeneSys, Inc.
01.2024 - 08.2024
Medical Claims Adjuster
United Healthgroup-Optum C&S
01.2018 - 07.2023
Bachelor of Arts - Business Management
Strayer University
GED -
Theodore Roosevelt H.S.
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