Jessica De La Rosa
Mason,TX
Summary
Hardworking and passionate job seeker With strong organizational skills eager to secure entry-level Medical Claims Processor position. 7 Years experience 4 which were remote from home. Ready to help team achieve company goals. Responsible, dedicated and Maintain Confidentiality and privacy for medical information and data. With strong attention to detail and juggles multiple tasks. Committed to handling claims expeditiously.
Overview
19
19
years of professional experience
Work History
Medical Claims Processor
ATP2 LLc
06.2016 - 09.2023
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Completed 200 claims daily
- Managed large volume of medical claims on daily basis.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Checked documentation for accuracy and validity on updated systems.
- Maintained confidentiality of patient finances, records, and health statuses.
- Processed and recorded new policies and claims.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Monitored and updated claims status in claims processing system.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations
- Managed large volume of medical claims on daily basis
- Researched and resolved complex medical claims issues to support timely processing
- Paid or denied medical claims based upon established claims processing criteria
- Evaluated medical claims for accuracy and completeness and researched missing data
- Monitored and updated claims status in claims processing system
- Identified and resolved discrepancies between patient information and claims data
- Reviewed provider coding information to report services and verify correctness
- Checked documentation for accuracy and validity on updated systems
- Maintained confidentiality of patient finances, records, and health statuses
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Processed and recorded new policies and claims
Medical Claims Specialist
FSC Camp Lejeune Family Members Program
10.2018 - 01.2019
- Submitted electronic/paper claims documentation for timely filing.
- Monitored and updated claims status in claims processing system.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Responded to correspondence from insurance companies.
- Researched and resolved complex medical claims issues to support timely processing.
- Generated reports on medical claims processing activities and results.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Identified and resolved discrepancies between patient information and claims data.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient finances, records, and health statuses.
- Generated, posted and attached information to claim files.
- Managed over 50 phones calls daily.
Medical Assistant
Texas Heart & Vascular
12.2011 - 05.2015
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Obtained client medical history, medication information, symptoms, and allergies.
- Performed medical records management, including filing, organizing and scanning documents.
- Collected and documented patient medical information such as blood pressure and weight.
- Called and faxed pharmacies to submit prescriptions and refills.
- Documented vital signs and health history for patients in clinic and hospital environments.
- Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
- Assisted with routine checks and diagnostic testing by collecting and processing specimens.
- Completed clinical procedures and gathered patient data for interpretation by physician.
- Taught patients about medications, procedures, and care plan instructions.
- Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment.
- Obtained and documented patient medical history, vital signs and current complaints at intake.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Completed EKGs and other tests based on patient presentation in office.
- Measured patient pulse oximetry.
- Implemented care and efficiency improvements to support and enhance office operations.
- Collected pertinent data and calculations to aid physician in interpreting results.
- Helped improve patient outcomes by educating and advising on relevant treatments and care.
- Managed 25 patients daily
Medical Assistant
Austin Heart
03.2005 - 05.2010
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Obtained client medical history, medication information, symptoms, and allergies.
- Performed medical records management, including filing, organizing and scanning documents.
- Collected and documented patient medical information such as blood pressure and weight.
- Documented vital signs and health history for patients in clinic and hospital environments.
- Completed clinical procedures and gathered patient data for interpretation by physician.
- Taught patients about medications, procedures, and care plan instructions.
- Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment.
- Obtained and documented patient medical history, vital signs and current complaints at intake.
- Completed EKGs and other tests based on patient presentation in office.
- Explained procedures to patients to reduce anxieties and increase patient cooperation.
- Measured patient pulse oximetry.
- Helped improve patient outcomes by educating and advising on relevant treatments and care.
- Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus.
- Managed over 25 patients daily
- Sanitized, restocked, and organized exam rooms and medical equipment
Education
Certified Medical Assistant - Medical Assisting
Allied Health Careers
Austin, TX06.1995
Skills
- Work Organizing and Prioritizing Understanding of medical terms
- Thorough Claims Reviews
- Microsoft Office
- Records Security Practices
- Microsoft Word
- Prior Authorization Processing
- Accuracy Verification
- Advanced Excel Spreadsheet Functions
- HIPAA
- Data Entry
- Task Prioritization
- Microsoft Word
- Electronic Health Records
- Medical Terms and Procedure Knowledge
- Insurance Claims
Timeline
Medical Claims Specialist
FSC Camp Lejeune Family Members Program
10.2018 - 01.2019
Medical Claims Processor
ATP2 LLc
06.2016 - 09.2023
Medical Assistant
Texas Heart & Vascular
12.2011 - 05.2015
Medical Assistant
Austin Heart
03.2005 - 05.2010
Certified Medical Assistant - Medical Assisting
Allied Health Careers
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