Jalissa Mendez

• Claim review and analysis: conduct retrospective reviews of medical and behavioral health claims for both inpatient and outpatient services
• .Use knowledge of clinical, coding, and processing guidelines to evaluate the appropriateness of care and determine if it aligns with program benefits.Information verification
• Evaluated claims for completeness and accuracy. Communicated with healthcare providers to gather further details on unclear claims.
• Determined correct benefit amounts and initiated payment processes or denials for claims, ensuring timely resolution.
• Adhered to HIPAA regulations to protect patient privacy while identifying potential fraud or quality issues, ensuring compliance with established processing guidelines.
• Managed claims processing tasks remotely, maintaining efficiency and accuracy in claim evaluations.

• Identity Confirmation: Verify individuals' identities using official ID or other accepted documentation.
• Document Review: Examine documents (passports, birth certs, etc.) for authenticity and adherence to standards (like REAL ID).
• Eligibility Checks: Determine if someone qualifies for services, benefits, or access (e.g., military benefits, post exchange).
• Managed accurate databases (like DEERS/RAPIDS) and generated reports to support identity verification processes.
• Record Management: Maintain accurate databases (like DEERS/RAPIDS) and create reports.
• Identified discrepancies and unauthorized access attempts to enhance fraud prevention measures.
• Managed military identification processes, including issuing ID cards and verifying eligibility.: Issuing ID cards (CAC), managing DEERS/RAPIDS, verifying eligibility for service members, families, and retirees.
• Background Screening: Validating employment history, education, and criminal records for new hire

• Effectively followed lesson plans, provided by absent teachers, ensuring continuity in student learning and minimizing disruptions in the classroom.
• Guided students with assignments and projects, enhancing their academic understanding and performance.
• Supported front office operations by tracking student attendance.
• Filling records, organizing school record for enrollment and did enrollment
• Assisted front office with attendance management, supporting accurate student tracking.
• Streamlined front office operations, enhancing efficiency in attendance tracking and record management.
• Ensured accurate and timely updating of school records, contributing to smoother enrollment processes.
• Provided personalized student support, aiding in academic challenges and promoting success.

• Guided customers through asset re-registration process following beneficiary death, ensuring clarity and support during a difficult time.
• Processed and resolved estate cases, managing queue of insurance plans and policies efficiently.
• Provided empathetic guidance to customers navigating asset re-registration.
• Delivered empathetic support to customers during asset re-registration, facilitating a smoother transition.
• Opening, processing, and resolving estate cases that are part of your case work and queue insurance plans, and policies.

• Verified insurance information to ensure patient eligibility and coverage, Signing patients in and out, Verifying appointments, Updated ICD 10 codes to maintain accurate patient records and facilitate billing,Maintained orderly filing system for efficient document retrieval, Prepared referral documents for patient consultations with specialists
• Greeted patients at Family Eye Care front desk with friendly, professional service.
• Scheduled eye exams and follow-up visits using office calendar systems.
• Answered phones and routed patient questions to appropriate staff members.

• Verified insurance information to ensure patient eligibility and coverage, Signing patients in and out, Verifying appointments, Changed ICD 10 code for accurate billing.,Maintained orderly filing system to ensure efficient document access., Prepared and submitted referrals to facilitate patient access to specialist care, Translated patient information for doctor during consultations.
• Greeted patients and managed front desk check-in at Family Eye Care.
• Answered calls and scheduled eye exams using appointment software.
• Verified patient information and updated records in office system.

Remote