Driven professional with a proven track record of consistently achieving and surpassing performance goals. Committed and diligent with a relentless commitment to delivering exceptional results.
Overview
24
24
years of professional experience
Work History
Business Operations Manager
Sweet Potato Pie Company
10.2016 - Current
Reviewed company's strategic plans and developed goals and standards to support vision.
Promoted energetic atmosphere with purpose to drive improvements in customer care and experiences.
Tracked trends and suggested enhancements to both challenge and refine company's product offerings.
Supervised creation of exciting merchandise displays to catch attention of customers.
Oversaw booth, selling food items to customers and maintaining sufficient stock of products and supplies to meet expected needs.
Issued product recommendation to customers to enhance sales and collected payment for desired purchases.
Delivered product to customer timely and efficiently.
Patient Account Representative
Memorial Hospital
07.2002 - 08.2013
Executed accounts receivable follow-up procedures by initiating timely collection activities after final billing, including secondary billing, appeals, and verification of revenue, CPT, HCPCS, and ICD-9 coding.
Ensured cash collections were maintained at optimum levels and days outstanding in receivables were minimized.
Utilization Management Specialist
Central Valley Medical Group
Modesto, CA
04.2002 - 07.2002
Managed a high volume of incoming authorization requests from various medical providers
Documented and supported utilization case management nurse during review process
Obtained and reviewed all essential medical records for authorization purposes
Ensured completion of tasks within required quick turnaround time in compliance with set time frames
Distributed all approvals and denials back to healthcare professionals via electronic submission or fax
Provided support to medical offices and facilities as needed, fostering strong working relationships.
Claims Processor
Allcare Ipa
Modesto, CA
10.2001 - 04.2002
Processed a high volume of claims daily in accordance with company standards
Ensured accurate entry and review of claims in company system
Revised policies and procedures to comply with changing local, state, and federal laws and regulations
Inputted data into system, verifying provider coding information and reported services
Streamlined office processes to align with long-term goals
Provided respectful assistance to patients, staff, and insurance company representatives
Participated in weekly review meetings to discuss operational policy revisions and new creations
Reviewed administrative guidelines to address questions during claims processing
Ensured accurate billing and payment of claims
Applied established criteria for claims processing to determine payment or denials
Communicated extensively with patients and providers to provide support and guidance on claims process
Stayed informed on HIPAA regulations, benefits claims processing, medical terminology, and procedures
Front Office Receptionist/Prior Authorization Specialist
Downey Park Family Practice
Modesto, CA
11.2000 - 10.2001
Provided courteous assistance to patients, staff members, and insurance company representatives
Streamlined office processes to align with long-term objectives
Disseminated information to appropriate departments, individuals, and external locations
Established a strong attendance record with emphasis on punctuality and readiness for work
Organized patient charts and inputted data into various software systems
Education
Associate -
Modesto Junior College
Modesto, CA
05.2003
Medical Office Specialist -
Andon Medical College
Modesto, CA
05.2000
Skills
Administrative Skills
Billing procedures
Computer Literate
CPT/HCPCS/ICD-11 Knowledge
Customer Service
Data Entry
Documentation
Epic Proficient
Fax
Insurance Knowledge
Internet Research
Kronos
Medical Billing
Medical Coding
Medical Manager
Medical Terminology
Meditech Proficient
Microsoft Office Proficient
Microsoft Outlook Proficient
Phone System/Scheduling
Receptionist
Typing 55 WPM
Vital Signs
Timeline
Business Operations Manager
Sweet Potato Pie Company
10.2016 - Current
Patient Account Representative
Memorial Hospital
07.2002 - 08.2013
Utilization Management Specialist
Central Valley Medical Group
04.2002 - 07.2002
Claims Processor
Allcare Ipa
10.2001 - 04.2002
Front Office Receptionist/Prior Authorization Specialist
Downey Park Family Practice
11.2000 - 10.2001
Associate -
Modesto Junior College
Medical Office Specialist -
Andon Medical College
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