Dawn Lucero
Tucson,AZ
Summary
Results-driven Claims Analyst II at Centene with expertise in claims analysis and process improvement. Demonstrated critical thinking and leadership by mentoring junior analysts and streamlining workflows, reducing processing times significantly. Proficient in Excel, I effectively identified trends to enhance accuracy and compliance, fostering a collaborative environment that improved team productivity.
Professional in insurance sector with robust background in claims analysis. Known for meticulous approach to examining claims and supporting team objectives through effective collaboration. Reliable and adaptable, consistently contributing to process improvements and accurate claims resolutions. Proficient in problem-solving and critical thinking.
Professional claims analyst with proven track record in evaluating, processing, and resolving insurance claims. Strong focus on team collaboration and adaptability, ensuring seamless operations and optimal outcomes. Highly skilled in data analysis, risk assessment, and customer service, consistently delivering reliable and efficient results. Known for excellent problem-solving abilities and maintaining high standards in all tasks.
Overview
15
15
years of professional experience
Work History
Claims Analyst II
Centene
02.2018 - Current
- Analyzed claims data to identify trends and discrepancies, improving accuracy of assessments.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently.
- Developed and implemented process improvements, enhancing productivity in claims handling.
- Reviewed and adjudicated claims according to regulatory guidelines, ensuring compliance and accuracy.
- Mentored junior analysts on best practices for claims processing and analysis techniques.
- Led initiatives to streamline claims workflows, resulting in reduced turnaround times for processing.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Reduced claims processing time by implementing efficient analytical techniques and strategies.
- Continuously sought opportunities to streamline workflows and implement process improvements within the claims department, resulting in increased efficiency and productivity levels.
- Streamlined workflow processes for improved efficiency and reduced claim resolution times.
- Mentored junior team members, sharing expertise in claims analysis techniques and fostering professional growth within the department.
- Identified trends in claim patterns, providing actionable insights for process improvements and risk mitigation strategies.
- Examined claims forms and other records to determine insurance coverage.
Medical Assistant
Tucson Family Practice
12.2015 - 12.2017
- Assisted in patient intake processes, ensuring accurate data entry and documentation.
- Conducted vital sign assessments and recorded health information for physician review.
- Coordinated scheduling of patient appointments to optimize workflow efficiency.
- Managed electronic medical records system, maintaining data accuracy and confidentiality.
- Supported clinical procedures by preparing examination rooms and organizing necessary supplies.
- Educated patients on treatment plans and medication instructions, enhancing patient understanding and compliance.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Obtained client medical history, medication information, symptoms, and allergies.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Performed medical records management, including filing, organizing and scanning documents.
- Facilitated seamless patient care with thorough and accurate documentation of medical histories, vital signs, and medications.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Ensured patient safety and comfort during examinations, effectively addressing concerns and answering questions.
- Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
- Maintained strict adherence to infection control protocols by following proper sterilization techniques for medical equipment.
Medical Receptionist
Tucson Family Practice
12.2015 - 12.2017
- Managed patient scheduling and appointment confirmations to optimize clinic efficiency.
- Coordinated communication between patients, physicians, and insurance providers to enhance service delivery.
- Maintained accurate patient records using electronic health record (EHR) systems for compliance and accessibility.
- Assisted in managing billing inquiries and resolving discrepancies to ensure timely payments.
- Oversaw daily front desk operations, ensuring smooth workflow and adherence to protocols.
- Implemented process improvements that reduced patient wait times and enhanced overall satisfaction.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Checked patient insurance, demographic, and health history to keep information current.
- Helped patients complete necessary medical forms and documentation.
- Maintained strict confidentiality of patient information, adhering to HIPAA regulations and medical office policies.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Managed high call volumes, directing calls to appropriate departments while maintaining a polite and professional demeanor.
- Managed multi-line phone system and pleasantly greeted patients.
- Provided compassionate customer service, creating a welcoming atmosphere for patients and their families.
- Maintained current and accurate medical records for patients.
- Enhanced patient satisfaction by efficiently managing the front desk operations and addressing inquiries in a timely manner.
- Developed strong relationships with patients, fostering loyalty and trust in the practice''s services.
- Assisted healthcare providers with administrative tasks, enabling them to focus on quality patient care.
- Contributed to a positive work environment by collaborating effectively with colleagues and supporting team initiatives.
- Kept waiting room neat and organized by stacking magazines, removing trash, and cleaning glass.
- Transcribed phone messages and relayed to appropriate personnel.
- Coordinated specialist referrals for patients requiring additional care, facilitating efficient transfer of medical records as needed.
- Supported office staff and operational requirements with administrative tasks.
- Handled billing procedures accurately, ensuring prompt payment from both patients and insurance providers.
- Organized essential medical documents, streamlining access to vital information for healthcare providers during appointments.
- Reduced no-shows by implementing appointment reminder system through phone calls or text messages.
- Facilitated effective communication between patients, medical staff, and insurance companies to ensure seamless coordination of care.
- Improved front office organization by implementing new filing systems and maintaining cleanliness in waiting areas.
- Managed patient appointments efficiently, reducing wait times significantly.
- Reduced administrative errors by consistently verifying insurance information.
- Improved workflow efficiency, organizing back-office supplies and equipment.
- Streamlined billing processes, ensuring accurate and timely invoicing.
- Facilitated smooth check-in process, ensuring all necessary paperwork was completed promptly.
Billing Specialist
Arizona Community Physicians
12.2014 - 12.2015
- Processed and verified patient billing information for accuracy and compliance with insurance regulations.
- Managed accounts receivable, ensuring timely collection of outstanding balances and reducing aged debt.
- Collaborated with healthcare providers to resolve billing discrepancies and enhance revenue cycle efficiency.
- Trained new staff on billing software and best practices, improving team productivity and knowledge retention.
- Conducted regular audits of billing processes to identify areas for improvement and implement corrective actions.
- Implemented electronic billing system improvements, resulting in reduced processing time and increased accuracy of claims submissions.
- Researched and resolved billing discrepancies to enable accurate billing.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Worked with multiple departments to check proper billing information.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
- Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
- Maintained detailed records of each account''s payment history, providing easy access to information for audit and analysis purposes.
Medical Assistant
Arizona Community Physicans
02.2011 - 12.2014
- Assisted in patient intake processes, ensuring accurate data entry and documentation.
- Conducted vital sign assessments and recorded health information for physician review.
- Coordinated scheduling of patient appointments to optimize workflow efficiency.
- Managed electronic medical records system, maintaining data accuracy and confidentiality.
- Supported clinical procedures by preparing examination rooms and organizing necessary supplies.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Obtained client medical history, medication information, symptoms, and allergies.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Performed medical records management, including filing, organizing and scanning documents.
- Built strong relationships with patients through effective communication skills that foster trust in the clinic''s commitment to quality care.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Ensured patient safety and comfort during examinations, effectively addressing concerns and answering questions.
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
Education
Associate of Arts -
Pima Community College
Tucson, AZHigh School Diploma -
Desert View High School
Tucson, AZMedical Assistant Certificate - Medical Assistant
Pima Medical Institute
Tucson, AZ05-2009
Skills
- Claims
- Claims analysis
- Interpersonal and written communication
- Policy interpretation
- Proficient in Excel
- Document workflow
- Claim investigation
- Claims review
- Claims trend analysis
- Accounting spreadsheets
- Claims history analysis
- Claims processing
- Coaching and mentoring
- MS office
- Critical thinking
- Computer skills
- Active listening
- Decision-making
- Team leadership
Timeline
Claims Analyst II
Centene
02.2018 - Current
Medical Assistant
Tucson Family Practice
12.2015 - 12.2017
Medical Receptionist
Tucson Family Practice
12.2015 - 12.2017
Billing Specialist
Arizona Community Physicians
12.2014 - 12.2015
Medical Assistant
Arizona Community Physicans
02.2011 - 12.2014
Associate of Arts -
Pima Community College
High School Diploma -
Desert View High School
Medical Assistant Certificate - Medical Assistant
Pima Medical Institute