Jaime Sellers

Riverside Physician network was acquired by Optum/Namm 2/2019

• Facilitated communication between healthcare providers and patients to ensure seamless service delivery.
• Reviewed, analyzed, and processed a high volume of appeals and claims accurately and efficiently
• Adjusted/Processed claims in accordance with policies, procedures, and regulatory guidelines
• Collaborated with cross-functional teams to streamline claims handling processes, enhancing workflow efficiency.
• Analyzed trends in claims data to identify potential risks and recommend preventive measures to management.
• Worked productively in fast-moving work environment to process large volumes of claims.
• Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
• Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
• Developed strong relationships with clients, facilitating trust and open communication during the claims process.
• Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
• Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
• Ensured timely resolution while maintaining attention to detail and compliance standards
• Managed multiple cases simultaneously, meeting strict deadlines in a fast-paced environment
• Communicated findings and resolutions clearly with internal teams

SoCal Medical Practice Concepts was a sister company within Riverside Physician Network which was acquired by Optum/Namm 2/2019

• Managed end-to-end billing and payment posting for multiple providers in a high-volume environment
• Posted and reconciled insurance reimbursements and patient payments with high accuracy
• Investigated account discrepancies and resolved billing issues efficiently
• Maintained compliance with payer requirements, billing regulations, and company policies
• Collaborated with cross-functional teams to support accurate financial records and revenue cycle operations
• Improved turnaround time and workflow accuracy through strong attention to detail and organization

Riverside Physician Network was acquired by Optum/Namm 2/2019

• Diagnosed and resolved technical issues across various platforms, enhancing user satisfaction.
• Provided first-level technical support to users via phone, email, and ticketing system
• Assisted with basic troubleshooting of hardware, software, and login/access issues
• Documented issues and resolutions accurately in support tickets
• Escalated complex technical problems to higher-level IT staff when appropriate
• Delivered professional customer service while resolving technical concerns efficiently

Riverside Physician Network was acquired by Optum/Namm in 2/2019

• Streamlined operations by implementing process improvements across various departments.
• Managed vendor relationships, ensuring compliance with service agreements and quality standards.
• Responded to inbound calls and assisted users with questions regarding medical charting and workflows within an Electronic Health Records (EHR) system
• Provided guidance on proper documentation, navigation, and system functionality to ensure accurate medical records
• Troubleshot basic system and workflow issues, escalating complex concerns as needed
• Delivered clear, professional support while maintaining compliance with healthcare privacy and documentation standards
• Supported efficient daily operations by helping users resolve issues quickly and accurately

Riverside Physician Network was acquired by Optum/Namm 2/2019

• Provided exceptional customer support, resolving inquiries and issues efficiently.
• Assisted patients with managing medical records.
• Leveraged electronic health record systems to maintain accurate patient information.
• Collaborated with healthcare teams to enhance patient experience and service delivery.
• Detail oriented supporting patients, providers, and internal teams across billing, claims and appeals.
• Proven ability to handle high call volumes, explain complex healthcare information clearly, and resolve issues accurately while maintaining HIPAA compliance. Strong communication, documentation, and problem solving skills.

Riverside Physician Network was acquired by Optum/Namm 2/2019

• Led initiatives to improve claims processing time by implementing new software tools and training staff accordingly.
• Developed training materials for onboarding new employees, facilitating a smoother integration into the team environment.
• Followed up with customers on unresolved issues.
• Processed claims efficiently, ensuring compliance with company policies and regulatory standards.
• Evaluated claim documentation for accuracy and completeness, reducing processing errors significantly.
• Provided exceptional customer service, addressing inquiries and resolving issues promptly for improved satisfaction.
• Mentored junior representatives on best practices in claims assessment and dispute resolution techniques.
• Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
• Served as a subject matter expert on specialized claims, providing guidance and support to other team members when needed.
• Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
• Provided exceptional customer service, addressing concerns and resolving issues promptly.
• Reviewed and updated claim processing guidelines, ensuring alignment with industry standards.
• Achieved high levels of accuracy in claim assessment, minimizing company's exposure to risk.
• Reduced claim resolution times with thorough documentation and timely follow-up.
• Conducted detailed investigations into suspicious claims, reducing instances of fraud.
• Streamlined interdepartmental communication, facilitating faster claim processing.
• Coordinated with healthcare providers to verify treatment plans and expenses.

• Prepared and cooked menu items following established recipes and quality standards.
• Operated kitchen equipment safely, ensuring adherence to health regulations and safety protocols.
• Trained new team members on food preparation techniques and operational procedures.
• Monitored inventory levels, coordinating with management to restock supplies as needed.
• Implemented process improvements to enhance kitchen efficiency and reduce wait times.
• Ensured cleanliness and organization of kitchen workspace, maintaining high sanitation standards.
• Collaborated with team members to optimize workflow during peak service hours.
• Maintained clean and organized work areas at all times to bring safety and quality to food preparation process.
• Maintained a clean and sanitary workspace, ensuring compliance with health and safety regulations.
• Prepared meals efficiently under time constraints for timely service during peak hours.
• Demonstrated strong multitasking skills, managing multiple orders simultaneously without sacrificing quality or presentation.
• Prepared food items in compliance with recipes and portioning control guidelines.
• Set up and prepared cooking supplies and workstations during opening and closing to maximize productivity.
• Managed time by organizing and prioritizing kitchen duties to prepare and serve food quickly.
• Prepared multiple orders simultaneously during peak periods with high accuracy rate, maximizing customer satisfaction, and repeat business.
• Changed and sanitized cutting boards, benches, and surfaces between tasks to avoid cross-contamination.
• Took food orders from cashiers and cooked items quickly to complete order items together and serve hot.
• Reduced food waste significantly by implementing proper portion control and storage techniques.
• Created identical dishes numerous times daily with consistent care, attention to detail, and quality.
• Enhanced customer satisfaction by consistently delivering high-quality, visually appealing dishes.
• Communicated closely with servers to fully understand special orders for customers.