Genesis Montero
Elizabeth,NJ
Summary
Results-driven Team Lead with extensive experience in claims adjustment and denial resolution. Skilled in leading diverse teams, driving operational efficiency, and achieving performance metrics. Adept at implementing process improvements, training associates, and fostering critical thinking to enhance productivity and quality outcomes. Known for excellent communication, strategic problem-solving, and building collaborative relationships across departments. Experienced in managing high-volume workflows, conducting quality audits, and leveraging data insights to meet and exceed service-level agreements (SLAs). Committed to delivering exceptional leadership and ensuring team success in dynamic healthcare operations environments.
Overview
9
9
years of professional experience
Work History
Operations Team Lead
Alma Community Health
07.2021 - Current
- Supervise a team of claims adjustment associates, ensuring daily productivity and quality targets are consistently met or exceeded.
- Monitor workflows to address claim denials and remittance actions, aligning team performance with service-level agreements (SLAs).
- Conduct quality assurance audits, providing constructive feedback and coaching to improve associate performance and critical thinking skills.
- Develop and implement streamlined processes to enhance efficiency, reduce errors, and improve claim resolution times. Facilitate team training on new tools, workflows, and industry best practices, ensuring full compliance with organizational policies.
- Lead team in handling complex claim scenarios, including out-of-network denials, by providing expertise and actionable strategies.
- Collaborate with cross-functional teams to address systemic challenges and improve overall operational performance.
- Prepare and deliver presentations to leadership on process updates, key initiatives, and team performance metrics.
Treatment Coordinator
Smile USA
05.2019 - 06.2021
- Researched billing issues, scheduled appointments and verified insurance coverage.
- Performed in team leader capacity and organized all treatment and placement activities.
- Reviewed X-rays to help patients determine best treatments.
- Laid out potential payment plans for patients.
- Educated patients on dental benefits and coordinated proper payment with insurance companies.
- Explained treatment choices to patients and helped determine best options.
- Conducted interviews with patients to discuss health history, objectives and concerns.
Dental Treatment Coordinator
212 Dental Care
01.2017 - 05.2019
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Helped patients complete necessary medical forms and documentation.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Understood dental terminology and insurance breakdowns to communicate with external stakeholders.
Assistant Manager
Retro Fitness Gym
01.2016 - 04.2017
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
- Generated repeat business through exceptional customer service.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Offered hands-on assistance to customers, assessing needs, and maintaining current knowledge of consumer preferences.
Education
Bachelor of Science - Biology
Kean University
06.2022
Skills
- Production
- Contract Management
- Health and safety compliance
- Process Improvement
Timeline
Operations Team Lead
Alma Community Health
07.2021 - Current
Treatment Coordinator
Smile USA
05.2019 - 06.2021
Dental Treatment Coordinator
212 Dental Care
01.2017 - 05.2019
Assistant Manager
Retro Fitness Gym
01.2016 - 04.2017
Bachelor of Science - Biology
Kean University
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