Hi, I’m
CHRISTINA TOLANO
Tucson,AZ
Summary
Dynamic Medical Claim Examiner with 14 years of comprehensive experience in health claims processing, specializing in Medi-Cal-based organizations. Expertise includes health insurance guidelines, claims auditing, and payment functions, ensuring accuracy and compliance throughout all phases of claims management. Proficient in various software applications, including Microsoft Office, SharePoint Central Database, Trizetto, and QNXT system, as well as ICD-10, CPT codes, and HCPCS codes. Recognized for exceptional attention to detail, strong customer service skills, and the ability to thrive in collaborative environments while effectively managing time and responsibilities.
Overview
21
years of professional experience
Work History
Self-Employed
Caregiver
03.2023 - 12.2025
Job overview
- Administer prescribed oral medications, under the written direction of a physician or as directed by a home care nurse or aide, and ensure patients take their medicine
- Care for patient by changing bed linens, washing and ironing laundry, cleaning, or assisting with their personal care
- Plan, purchase, prepare, or serve meals to patient according to prescribed diet
- Accompany patient to doctors' offices or on other trips outside the home, providing transportation, assistance, and companionship
- Provided personalized care and support to client in daily activities, enhancing quality of life.
- Assisted clients with mobility and personal hygiene, ensuring comfort and dignity.
Contact One
Virtual Receptionist
01.2021 - 03.2023
Job overview
- Enhanced internal communication by promptly forwarding urgent messages or requests to the appropriate personnel within the organization.
- Served as an integral part of the virtual reception team through consistent reliability and punctuality during scheduled shifts.
- Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
- Managed multi-line phone systems to ensure prompt and accurate call handling.
- Provided exceptional customer support through effective communication and problem-solving skills.
- Enhanced customer satisfaction by promptly answering and directing incoming calls to appropriate departments.
Alorica Inc.
Customer Care Representative
12.2019 - 11.2020
Job overview
- Answered telephone calls from medical providers to receive authorizations for non-formulary, quantity limits, and prior authorizations for specialty medications
- Handled customer complaints efficiently and politely
- Transferring calls to the appropriate destination
- Called and transferred calls to pharmacies to complete authorization cases
- Resolved customer inquiries effectively through active listening and problem-solving techniques.
- Managed high-volume calls with professionalism, ensuring customer satisfaction and loyalty.
- Collaborated with team members to enhance service delivery and streamline processes.
Kern Health Systems
Claim Examiner 1
01.2005 - 04.2019
Job overview
- Enter claim payments, reserves, and new claims on the computer system, inputting concise yet sufficient file documentation
- Examine claims forms and other records to determine insurance coverage
- Prepared and reviewed CMS 1500 and UB04 forms and related documents
- Review insurance policy to determine coverage with proper billing coding with CPT and ICD-10 and ICD-14 submissions
- Observed with all HIPPA laws and regulations, as well as staying up to date with all training
- Applied insurance guidelines for coverage and payments
- Contact the authorization department to ensure procedures are covered
- Calculated amount of payment to claims with additional coverage.
- Processed all claims using Trizetto QNXT compliance system as well as used Managed Health Care systems to all data entry of claims.
- Reviewed claims for accuracy and compliance with regulatory standards.
- Collaborated with healthcare providers to resolve claim discrepancies effectively.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
Education
San Joaquin Valley CollegeBakersfield, CA
Associate's Degree from Medical/Clinical Assistant
02-2001
Bakersfield Adult School Bakersfield, CA
GED
05-1993
Skills
- Supportive engagement
- Effective time management
- Personalized elder care
- Strategic issue analysis
- Professional phone communication
- Customer service
- Proficient in computer applications
- Detail-oriented data management
Affiliations
Kingdom Come Christian Ministries
Kern Health Systems
AppleOne Employment
San Joaquin Valley Community College
Languages
Spanish
Elementary
Interests
- Cooking
- Exploring famous landmarks, historical sites, and cultural attractions in a new destination.
- Road Trips
- Homelessness Outreach
- Church involvement
- Choir
- Ministry
Timeline
Caregiver
Self-Employed
03.2023 - 12.2025
Virtual Receptionist
Contact One
01.2021 - 03.2023
Customer Care Representative
Alorica Inc.
12.2019 - 11.2020
Claim Examiner 1
Kern Health Systems
01.2005 - 04.2019
San Joaquin Valley College
Associate's Degree from Medical/Clinical Assistant
Bakersfield Adult School
GED