Eugenia Sanchez
Red Oak,TX
Summary
Effective Medical Claims Manager with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Business-minded with exemplary skills in customer service, time management and service coordination.
Overview
15
15
years of professional experience
Work History
Senior Medical Claims Examiner
UnitedHealthcare
10.2018 - Current
- Expertly navigated disputes between parties involved in the claiming process, leading to fair resolutions.
- Collaborated with healthcare providers to ensure accurate billing information, minimizing discrepancies and errors.
- Mitigated risk exposure by adhering to all policies and regulations governing the medical claims examination process.
- Developed strong relationships with healthcare professionals, fostering trust and cooperation for smoother claims processing.
- Improved claim processing efficiency by implementing new medical claims examination practices and procedures.
- Maintained thorough knowledge of medical terminology and coding systems, contributing to precise evaluations of claim submissions.
- Mentored junior examiners, sharing expertise and guidance to improve overall team performance.
- Implemented quality control measures to maintain high accuracy levels in the claims examination process.
- Served as a subject matter expert in company audits, providing insights into effective medical claims examination practices.
- Managed large volume of medical claims on daily basis.
- Organized, planned and documented materials for Medicare claims.
Lead Optometric Manager
VisionSource Waxahachie
02.2014 - 10.2018
- Provided exceptional customer service, addressing patient concerns promptly and professionally.
- Developed strong relationships with local physicians, fostering referrals and collaboration for comprehensive patient care.
- Trained new staff members on optical equipment usage and best practices, ensuring consistent quality of care.
- Managed administrative duties with phone reception, appointment scheduling and payment processing.
- Collaborated with optometry staff to reach individual and team goals.
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
Optometric Assistant
Dr. Austin Ruiz O.D.
11.2009 - 12.2013
- Performed pre-testing procedures, enabling optometrists to focus on comprehensive examinations and personalized recommendations.
- Collaborated with insurance providers to verify coverage, facilitating smooth transactions for both patients and the practice.
- Assisted optometrists in conducting eye exams for accurate diagnosis and treatment planning.
- Managed billing processes efficiently, resolving any discrepancies promptly to maintain positive patient relationships.
- Ensured accuracy of patient records by diligently updating information during each visit or interaction.
- Streamlined appointment scheduling, resulting in improved patient flow and reduced wait times.
Education
Bachelor of Science in Healthcare Administration -
Grand Canyon University
Phoenix, AZ05.2024
Skills
- 8 years of Medical Insurance Billing and CPT coding usage experience
- 8 years in a Customer Service environment
- Healthcare regulations knowledge
- Process and adjust claims when errors are identified
- Critical Thinking Capacity
- Strong Communication Skills
- Claims Processing Proficiency
- Project management experience
- Training and Mentoring Experience
- Staff Management
References
- Briya Dancer, Colleague, (469) 859-2855
- Zoyla Solis, Colleague, (956) 212-9207
Timeline
Senior Medical Claims Examiner
UnitedHealthcare
10.2018 - Current
Lead Optometric Manager
VisionSource Waxahachie
02.2014 - 10.2018
Optometric Assistant
Dr. Austin Ruiz O.D.
11.2009 - 12.2013
Bachelor of Science in Healthcare Administration -
Grand Canyon University
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