Joseph Cortez
San Antonio,USA
Summary
- Claims Examiner with extensive experience managing high volumes of claims and resolving provider disputes through meticulous claims adjudication and regulatory compliance
- Delivered process improvements that enhanced efficiency and productivity while maintaining exceptional communication and client satisfaction
Detail-focused Medical Claims Examiner known for productivity and efficiency in task completion. Specialize in medical billing codes, claims analysis, and regulatory compliance to ensure accuracy and adherence to guidelines. Excel in problem-solving, communication, and time management skills, enhancing team collaboration and meeting tight deadlines.
Overview
26
26
years of professional experience
Work History
Contract Configuration Specialist
Wellmed Medical Management
San Antonio, USA
07.2018 - 04.2026
- Implemented and configured provider contracts in computer system, streamlining contract integration for claims processing.
- Managed and configured contract methodologies for claims payment system, ensuring adherence to project deadlines and accuracy in processing.
- Tested claims against for payment accuracy against contract configuration loaded into claims payment system
- Addressed customer service issues related to claim disputes by reviewing contracts, benefits, and codes to validate accurate billing.
- Focused on achieving departmental timeframes and maintaining quality metrics.
- Took ownership of work processes. identified improvements for job and process efficiency. and suggested solutions to management Ability to multitask and change focus to accommodate meeting of team objective, and deadlines
Claims Specialist
WellMed Management LLC
San Antonio, USA
07.2017 - 07.2018
- Continuously met and exceeded quality measures and daily processing goals to enhance service delivery
- Leveraged resources to ensure accurate and timely claim processing, supporting organizational objectives
- Achieved quality measures and met daily processing targets, contributing to operational efficiency
- Applied correct benefits to claims across multiple contracts
- Collaborated with various departments on special projects
Technical Claims Specialist
Aetna/Coventry
San Antonio, USA
09.2007 - 02.2014
- Achieved and surpassed quality measures and daily processing goals
- Leveraged resources to ensure accurate and timely claim processing
- Assessed and routed claims to appropriate departments based on medical or mental classification
Merchandise Receiver
New York & Company
San Antonio, USA
04.2000 - 04.2008
- Received and checked merchandise to ensure accuracy for shipment
- Separated and hung merchandise in designated according store requirements
- Folded clothes and organized store displays to enhance visual appeal and meet customer expectations
- Greeted customers warmly and assisted with purchases, credits, and returns to promote positive shopping experience
- Welcomed customers with a friendly demeanor and assisted with purchases, credits, and returns to promote positive shopping experience
3rd Year Electrical Apprentice
Bexar Electric
San Antonio, USA
02.2002 - 01.2007
- Installed plugs, switches, fans, recessed lights, meter loops, panels, breakers, and smoke detectors, ensuring compliance with state regulations to enhance safety and functionality
- Installed electrical systems in newly constructed homes and businesses, contributing to timely project completion and customer satisfaction
- Installed electrical feeders for HVAC systems for a/c units, furnaces, stoves, dryers and washers
- Installed romex wire according to project blueprints and conduit to each destination per blueprints
- Provided support to customers regarding project timelines as well as contractors in regards to work timeline
Education
Medical Billing & Coding - Medical Administrative Assistant Program
Job Ready Training
San Antonio, TXElectrical Trades -
St Philip's College
San Antonio, TXSkills
- Compliance management
- Collaboration
- Communication skills
- Claims examination
- Contract configuration
- Claims processing
- Payment accuracy
- Methodology management
- Systems testing
- Project coordination
- Problem solving
- Attention to detail
- Microsoft Excel
- Time management
Timeline
Contract Configuration Specialist
Wellmed Medical Management
07.2018 - 04.2026
Claims Specialist
WellMed Management LLC
07.2017 - 07.2018
Technical Claims Specialist
Aetna/Coventry
09.2007 - 02.2014
3rd Year Electrical Apprentice
Bexar Electric
02.2002 - 01.2007
Merchandise Receiver
New York & Company
04.2000 - 04.2008
Medical Billing & Coding - Medical Administrative Assistant Program
Job Ready Training
Electrical Trades -
St Philip's College