CLAUDIA VALENCIA
Bell,Ca
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
13
13
years of professional experience
Work History
Business Office Assistant - Billing
Kei-AI Los Angeles Health care Center
2021.11 - Current
- Process manage care claims via mail / waystar, call health plans for eligibility of benefits for Nursing Facility, input patient insurance information on system, follow up on denials and resubmit claim, bill custodial care (LTC) claims, run eligibility every week, deposit payments on online banking, answer phones call from Health plans/patient family, process payment for patient on persona pay system, follow up on aging and re process denial claims, Daily census, collect payments from patients or patient family, appeal denial claims on line or via mail.
Care Coordinator II
Health Care partners
2016.09 - 2021.11
- Processes referral in the referral portal, coordinates and assist with patient appointments as needed, coordinates snf placement for patient, create referral when patients are admitted or in observation at hospital, review daily census report , distribute census to management, do NOMNCs needed for all Senior plan SNF d/c’s, Daily census, snf placement, submitted appointment on IWS system, fax records to scanning company, Assists with answering telephones and maintaining files, logs or other reports, Processes referrals for inter-facility transfers using pre-established guidelines, Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate, Processes referrals for durable medical equipment and coordinates home health services according to established policies, procedures and guidelines.
Authorization Coordinator
St Joh’s Well child and Family Center
2011.03 - 2016.08
- Process authorization for county , IPA patients, schedule appointments for patient with specialist, mail appointment letters, log in spread sheet, data entry, and make report every month, enter patient information on I2I system, process over 50 referrals a day ,answer phone, verify patient eligibility, request member to be added in IPA system when not available, obtain specialist reports
Education
Medical Billing -
Everest College - Gardena
Gardena, CASkills
- Scheduling and Planning
- File Organization
- Office Management
- Data entry expertise
Summaryqualifications
- Insurance verification
- E-consul program / Med point / AppleCare IPA systems / HCP Intranet / CCMIS system/ touch works system
- Centricity-practice solution version 12
- Microsoft word / Outlook ,Word, Excel
- Typing 45 wpm
- I2I tracks
- RPS System ( county)
- Knowledge of medical terminology and CPT/ICD-9-10
- Ability to manage time effectively and work independently
- PointClick Care system / Waystar system / Medical system/ Office Ally System
- Avality system, UB-1500, UB-4, Mcal long term care, Management co-insurance medical
Languages
Spanish
Full Professional
Timeline
Business Office Assistant - Billing
Kei-AI Los Angeles Health care Center
2021.11 - Current
Care Coordinator II
Health Care partners
2016.09 - 2021.11
Authorization Coordinator
St Joh’s Well child and Family Center
2011.03 - 2016.08
Medical Billing -
Everest College - Gardena
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