John Flores
Sacramento,CA
Summary
Results-driven professional with expertise in managing client inquiries, billing processes, and diverse administrative tasks. Strong understanding of contracts and documentation that impact billing operations. Proficient in preparing polished statements and crafting professional business correspondence to enhance communication and foster positive client relationships. Committed to delivering exceptional service while ensuring accuracy and attention to detail in all work aspects.
Overview
20
20
years of professional experience
Work History
Payment Poster 2
Dignity
02.2024 - Current
- Duties include posting member payments from pending status to completed one. Making sure member payments is reflected in their balance and funds have been successfully applied to their accounts. Whether its credit card or check payments from member confirming the payment has reduced their balance owed. Duties also include correction or movement from one balance to another or member to member. I also review a monthly missing payment file to verify if any payment was late or not posted. If any was not posted I would make sure that was done.
Claims processor 2
River City Medical Center
02.2023 - 12.2023
- Duties include review and process claims for multiple services such as physical therapy, surgeries, office visits ,etc. Duties also included calling hospitals and clinics to obtain and verify authorizations for multiple services. Projects such as adjusting previously processed claims for corrected payment denial or payment codes or interest if required. Pricing for multiple surgery claims and making sure the rates have been updated per Medical or contracted agreement with hospital.
Quality Analyst
Sutter Physician Services, Rancho Cordova, CA
Rancho Cordova, CA
04.2013 - 11.2021
- Duties include review claims make sure they were processed correctly. Verify that the correct contract copay or claim denials were applied to the claims processed. Auditing the keying portion making sure the claim image matches what is entered in our system. Also auditing research portion making sure adjusted claims were processed correctly. I just started auditing the eligibility department making sure the member’s coverage and information is correct. Was lead for a period of time so also audited our team make sure nothing was missed. Made sure each auditor had claims to audit in their queue. Weekly meeting with the claims eligibility and mail team to discuss updates. Gather information on what we worked on and errors found on a monthly bases.
Claims Examiner 2
Sutter Physician Services, Rancho Cordova, CA
Rancho Cordova, CA
11.2010 - 01.2013
- Duties include to reviewing and processing claims into our system. Making sure they are priced correctly. Reading the DOFR see who is responsible. Verifying claim is being priced at correct rates and if authorization is correct if needed if claim is being denied make sure correct denial code is entered. When need helping with data entry entering claim information or authorizations into our Epic system. Adjusting claim for any corrections sent by provider or errors made.
Claims Examiner
Health Net, Rancho Cordova, CA
Rancho Cordova, CA
05.2007 - 08.2010
- Duties include but not limited to reviewing the detail of a claim and processing the claims in a high volume environment at times into our system. Adjusting the claims with additional information sent by the provider. Products include Standard HMO, CSP, AIM, Healthy Families, and Sutter HMO.I also audited varies types of claims for a brief period.
Customer Service Consultant
Gap Inc. Direct, Rocklin, CA
Rocklin, CA
10.2005 - 07.2007
- Duties include but are not limited to managing customers inquires By providing product information and processing orders, able to handle High volume of calls in a fast pace environment, have strong PC skills Including Internet and windows based.
Claims Processor
Ehealthline, Sacramento, CA
Sacramento, CA
01.2007 - 05.2007
- Duties include but not limited to data entry of claims, and the processing and uploading of claims accurately and efficiently.
Education
High School Diploma -
Grant Adult Ed
Sacramento, CA07-2003
Skills
- Effective communication skills
- HIPAA compliance
- Accurate data entry
- Insurance verification
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Payment Poster 2
Dignity
02.2024 - Current
Claims processor 2
River City Medical Center
02.2023 - 12.2023
Quality Analyst
Sutter Physician Services, Rancho Cordova, CA
04.2013 - 11.2021
Claims Examiner 2
Sutter Physician Services, Rancho Cordova, CA
11.2010 - 01.2013
Claims Examiner
Health Net, Rancho Cordova, CA
05.2007 - 08.2010
Claims Processor
Ehealthline, Sacramento, CA
01.2007 - 05.2007
Customer Service Consultant
Gap Inc. Direct, Rocklin, CA
10.2005 - 07.2007
High School Diploma -
Grant Adult Ed