ENAJ CANDO
Chula Vista,CA
Summary
Enthusiastic about helping patients get necessary medical support by obtaining authorizations, scheduling procedures and coordinating paperwork. Detail-oriented and proactive with good relationship-building skills, a hardworking nature and an adaptable approach.
Overview
6
6
years of professional experience
Work History
Claims Analyst
Community Health Group
06.2023 - Current
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims and maintaining high numbers of production as well as high quality scores.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Ensured to follow billing practices according to MediCal guidelines.
- Utilized proper analysis of submitted Explanation of Benefits from outside insurances in order to coordinate precisely and efficiently.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions. Ensured every claim is properly documented with concise memos and remits when called for.
- Practiced efficient communication between analysts and management.
- Proficient in utilizing Sharepoint, QNXT, eVIPS, and Microsoft Office applications.
Patient Service Representative
OPSAM HEALTH
11.2022 - 05.2023
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
- Tackled numerous patient concerns in a timely manner whilst completing other tasks in a fast-paced environment.
- Managed the front desk at clinic that maintains multiple providers a day with a variety of specialties and services that rotate through the week. Organized and scheduled appointments in a timely manner.
- Prepared for upcoming workday by verifying insurances, making note of copays, stocking, and copying all necessary documents. Handled and maintained patient charts.
- Audited weekly cash and credit payments. Prepared deposits for bank to receive from both the medical and dental offices.
- Assisted patients with concerns or questions about insurance policies and benefits, available healthcare programs, and their referrals.
- Managed patient registration process, confirming data accuracy and completeness.
- Managed waiting room operations effectively, addressing any issues or concerns that arose during peak hours.
Registered Behavior Technician
ACES
03.2022 - 11.2022
- Promoted positive behavior change by utilizing reinforcement strategies, token economies, and behavior contracts.
- Improved client behavior by implementing individualized ABA therapy plans and tracking progress.
- Prevented instances of maladaptive behavior escalation using de-escalation techniques while maintaining a safe environment for both staff members and clients alike.
- Observed, monitored and recorded problem behaviors through accurate behavior-consequence data collection, graphs, and anecdotal notes.
- Established efficient communication with Supervisors to help create and structure the behavior plans to ensure best execution of treatment.
- Established rapport with the guardians/parents of the children to establish a harmonious working relationship that can greater benefit the child.
Waitress
Sushi Namu
11.2019 - 03.2022
- Handled high-pressure situations with composure, maintaining excellent service standards even during busy shifts.
- Maintained a clean and organized dining area, contributing to a pleasant atmosphere for guests.
- Exhibited strong multitasking abilities, balancing multiple tables and orders while delivering prompt service.
- Handled cash transactions accurately in order to minimize discrepancies at the end of shifts.
Hostess
Pho Hiep Grill
03.2018 - 10.2018
- Greeted customers warmly upon arrival and provided friendly and warm presence throughout dining experience.
- Took reservations and to-go orders by phone, answered customer questions, and informed of accurate wait times.
- Used cash registers and credit card machines to cash out customers.
Education
Bachelor of Science - Cognitive And Behavioral Neuroscience
University of California - San Diego
La Jolla, CA07.2022
Skills
- Proficient in Excel
- Proficient in Microsoft Office
- Data Entry and Record Keeping
- Claims review
- HIPPA Regulation
- Compliance
- Customer service and support
- Medical billing guidelines
Timeline
Claims Analyst
Community Health Group
06.2023 - Current
Patient Service Representative
OPSAM HEALTH
11.2022 - 05.2023
Registered Behavior Technician
ACES
03.2022 - 11.2022
Waitress
Sushi Namu
11.2019 - 03.2022
Hostess
Pho Hiep Grill
03.2018 - 10.2018
Bachelor of Science - Cognitive And Behavioral Neuroscience
University of California - San Diego
Similar Profiles
ALEJANDRO SANDOVALALEJANDRO SANDOVAL
Member Services Representative at Community Health GroupMember Services Representative at Community Health Group
Mai CabreraMai Cabrera
Medical Transportation Driver at Community Health GroupMedical Transportation Driver at Community Health Group
Andres GarciaAndres Garcia
Member Services Representative at COMMUNITY HEALTH GROUPMember Services Representative at COMMUNITY HEALTH GROUP
Celina RojoCelina Rojo
Member Service Specialist at Community Health GroupMember Service Specialist at Community Health Group
Ana Sofia LeonardAna Sofia Leonard
Social Media Marketing Director at Double Deuce & Whiskey GirlSocial Media Marketing Director at Double Deuce & Whiskey Girl