Janet Hernandez
Sacramento,CA
Summary
With over 15 years of experience in the healthcare industry, dedicated and compassionate professional committed to providing high-quality patient care. Expertise in performing medical procedures and maintaining accurate patient records. Excels in collaborating with multidisciplinary teams to ensure comprehensive care for all patients. Possesses knowledge of various insurance systems such as Medicare, Medi-Cal, Worker\'s Comp, and Managed Care (HMO, PPO, POS, etc.), enhancing ability to navigate the complexities of the healthcare landscape.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Program Coordinator
Health Net, Inc
10.2023 - Current
- Initiate authorization requests for output or input services in keeping with the prior authorization list
- Research claims inquiry specific to the department and responsibility
- Phone usage - Outbound calls to medical groups
- Medical review unit
- Claims dept sends cases to MRU team, theylook at each case to determine if the service requires an authorization
- Checking status of authorizations
- Provider appeals - will receive medical records and review to determine next steps
Disability Analyst
Insurance & Benefit trust
11.2022 - 03.2023
- Read and interpret medical records in connection with claims filed for all the riders and determine if the insured qualifies for claim approval based on the medical condition and the terms and provisions of the rider
- Responsible for the processing of the claim in our administration systems
- Prepares monthly reports for audit and bookkeeping.
Remote Medical Coder
Global Medical Response
01.2022 - 07.2022
- Assigned Correct CPT codes, ICD-10 CM codes
- Ensure accuracy of coding for non-emergency hospital discharge claims
- Complying with medical coding and guidelines and policies
- Receiving and reviewing patient's charts and documents for verification and accuracy
- Serve as resource and subject matter expert to other coding staff.
Claims Analyst
Centene
05.2021 - 12.2021
- Apply policy and provider contract provisions to determine if the claim is payable, if additional information is needed, or if the claim should be denied
- Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds, and/or adjustments on resubmitted claims
- Research and determine the status of medical-related claims
- Meet department production and quality standards.
Medical Biller
SCA Affiliates
12.2018 - 05.2021
- Review 30-80 claims, ensuring authorization is obtained and CPT codes are entered correctly
- Assigned ICD-9-CM codes for procedures and diagnoses; entered and verified abstract data elements
- Analyzed medical records to assign the appropriate CPT ICD-9-CM and HCPCS codes
- Assign diagnosis and procedure using ICD9-CM and CPT-4 codes
- Review and analyze medical records against billed procedures to ensure the accuracy of diagnostic and Evaluation and Management codes
- Meditech
Customer Service Rep
Sutter Shared Services
08.2018 - 11.2018
- Assisted customers via phone, email, and live chat, addressing inquiries, resolving issues, and providing product information
- Achieved a consistent customer satisfaction rate of over 95% through effective problem-solving and attentive communication
- Handled escalated customer concerns and complaints, de-escalating situations and finding satisfactory resolutions
- Maintained accurate and detailed records of customer interactions in the CRM system.
Claims Examiner
HealthNet
06.2015 - 06.2017
- Approve, reject, or refer to a claim to a specialist
- Diligently review reports to ensure that no errors have been made in the appraisal process
- Consistent with applicable policies, procedures, and department guidelines.
Health Service Representative
Santa Clara County Health and Hospitals
02.2011 - 03.2014
- Recorded and filed patient data and medical records
- Liaised between patient and medical support staff
- Scheduled appointments and cancelled appointments
- I registered new patients quickly and in a timely manner.
Client Service Representative
Santa Clara County Medi, Cal
04.1998 - 02.2011
- Provided customer service skills to clients with explanations on eligibility for benefits and billing
- Responded to customer billing and payment inquiries
- Initiating and validating referrals/authorizations
- Gathered information necessary for accurate registration including assigning of Medical
Education
Diploma - Gender Studies
San Jose Metropolitan
San Jose Skills
- ICD-10
- Medical Coding
- Medical Receptionist
- Medical Terminology
- ICD-9
- Insurance Verification
- Claims processing
- Customer service
- Attention to detail
- Escalation handling
- Problem resolution
- Epic training
Certification
Certified Professional Coder (CPC), 12/01/13, Present
Languages
Spanish
Native or Bilingual
Timeline
Program Coordinator
Health Net, Inc
10.2023 - Current
Disability Analyst
Insurance & Benefit trust
11.2022 - 03.2023
Remote Medical Coder
Global Medical Response
01.2022 - 07.2022
Claims Analyst
Centene
05.2021 - 12.2021
Medical Biller
SCA Affiliates
12.2018 - 05.2021
Customer Service Rep
Sutter Shared Services
08.2018 - 11.2018
Claims Examiner
HealthNet
06.2015 - 06.2017
Health Service Representative
Santa Clara County Health and Hospitals
02.2011 - 03.2014
Client Service Representative
Santa Clara County Medi, Cal
04.1998 - 02.2011
Diploma - Gender Studies
San Jose Metropolitan
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