Crystal Cortez
San Antonio,TX
Summary
Organized and dependable candidate seeking to establish a position as a recovery resolution analyst. Skilled at navigating complex dental claims and appeals, I honed critical thinking and customer service excellence at UnitedHealth Group. By utilizing dental terminology knowledge and analytical prowess, I triaged dental appeals efficiently and effectively.
Have great communication and teamwork skills, with the ability to adapt to new environments. Eager to contribute to team success and further develop professional skills.
Overview
13
13
years of professional experience
Work History
Appeals Representative
UHG, United Health Group
12.2024 - Current
- Triaged, reviewed, and prioritized dental appeals for claims and predeterminations.
- Review and investigate diverse appeals concerns.
- Gathered relevant data for resolving claim appeals.
- Understand how a claim is processed, and why it was denied.
- Obtained additional documentation required for case review.
- Managed sensitive client information with confidentiality and discretion.
- Expedited the appeals process for faster resolutions by streamlining procedures and workflows.
- Enhanced the accuracy of appeal decisions through thorough research and factchecking.
Dental Claims Representative
UHG, United Health Group
05.2023 - 11.2024
- Worked productively in fast-moving work environment to process large volumes of claims.
- Maintained compliance by adhering to established procedures and guidelines in claims handling.
- Applied knowledge of standard operating procedures toward claims and predeterminations.
- Reviewed, researched, and investigated ADA codes for appropriate processing.
Customer Service Representative Level 1
UHG, United Health Group
06.2022 - 05.2023
- Maintained member satisfaction by answering account questions, educating about insurance, and resolving concerns.
- Adhered to strict HIPAA guidelines to protect members' privacy.
- Investigated claim details regarding general dentistry and specialist dentistry.
- Educated on PPO, HMO, Medicaid, and Medicare insurance and policies.
Call Center Customer Service Agent
Charter Spectrum
06.2020 - 06.2022
- Recommended internet and video products to customers, thoroughly explaining details.
- Educated customers about billing, online payment processing and returned equipment procedures.
- Resolved video and internet repair issues over phone with 50-60 customers daily.
- Effectively communicated with customers about account changes, new video/internet products or services and potential TV package upgrades.
Dental Front Office Coordinator
Smileworkshop Dentistry
06.2018 - 06.2020
- Updated and edited dental treatment plans for correct claim processing.
- Prepared insurance claim forms, explained benefits, and outlined pricing details for procedures and services.
- Answered telephone calls about office information, billing questions, and ADA claim reimbursement.
Dental Front Office Coordinator
DentalOne Partners Inc.
08.2012 - 06.2018
- Secured sign-in sheets, dental charts, and provided treatment plans, with insurance benefits verified.
- Coordinated referrals through insurance, other medical specialists, and documented details in patient charts.
- Managed office bookkeeping, with insurance billing, claim processing, and patient payments.
Education
Bachelor of Science - Kinesiology
The University of Texas At San Antonio
San Antonio, TX05.2012
Skills
- Critical Thinking
- Strong Analytical and Problem-Solving Skills
- Insurance Coverage Verification
- Microsoft Office, Facets, ISET, ACET
- Teamwork
- Multitasking skills
Timeline
Appeals Representative
UHG, United Health Group
12.2024 - Current
Dental Claims Representative
UHG, United Health Group
05.2023 - 11.2024
Customer Service Representative Level 1
UHG, United Health Group
06.2022 - 05.2023
Call Center Customer Service Agent
Charter Spectrum
06.2020 - 06.2022
Dental Front Office Coordinator
Smileworkshop Dentistry
06.2018 - 06.2020
Dental Front Office Coordinator
DentalOne Partners Inc.
08.2012 - 06.2018
Bachelor of Science - Kinesiology
The University of Texas At San Antonio
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