Jerrica Gomez
San Antonio,TX
Summary
Highly skilled in medical claims adjustment with background in examining, evaluating, and managing insurance claims. Known for strong analytical skills and thorough understanding of medical terminology, coding, and billing processes. Strengths include efficient processing of high-volume claim files and ability to negotiate fair settlements while maintaining compliance with policy provisions and applicable laws. Demonstrated impact through streamlined workflows and improved cost-efficiency in prior roles.
Overview
3
3
years of professional experience
Work History
Medical Claims Adjuster
Allcat Claims Service
San Antonio, TX
01.2021 - 04.2024
- Reviewed medical records to determine the appropriateness of services rendered and billed by healthcare providers.
- Analyzed medical claims for accuracy, completeness, and compliance with company policies and procedures.
- Investigated discrepancies in medical billing codes, patient information, and other data related to claims processing.
- Resolved complex claim issues through research, negotiation, and collaboration with other departments.
- Documented all decisions made on claims in accordance with established guidelines.
- Developed strategies for reducing costs associated with claims processing.
- Provided customer service support to healthcare providers regarding denied or disputed claims.
- Performed quality assurance reviews of submitted insurance claims prior to payment approval.
- Evaluated potential fraud cases involving healthcare providers or patients as necessary.
- Maintained accurate records of all activities related to claim adjustments.
- Reviewed claims for accuracy before submitting for billing.
- Participated in training sessions designed to keep current on industry-specific regulations.
- Assessed claim denials to determine if appeals are appropriate.Identified suspicious claims, escalating issues to supervisor for further investigation and analysis. Self-motivated,
with a strong sense of personal responsibility.
Education
Certificate In Medical Assistant -
Southern Careers Institute Inc
San Antonio07-2017
Skills
- Strong analytical skills
- Conflict resolution techniques
- Insurance claims processing
- Insurance claims management
- Proficiency in Guidewire, ALR, IAA, CCC, and ISO
- Claim validity determination
- Insurance Claims
- ASC Coding
- Effective communication abilities
Timeline
Medical Claims Adjuster
Allcat Claims Service
01.2021 - 04.2024
Certificate In Medical Assistant -
Southern Careers Institute Inc