J. R. Miller
Sacramento,CA
Summary
Seasoned Medical Claims Examiner with 16 years of experience in claims processing, analysis, and customer service. Proficient in medical coding (ICD-10, CPT, HCPCS) and ensuring compliance with HIPAA and CMS guidelines. Currently transitioning into the field of substance abuse counseling as a RADT, and pursuing education to become a Drug and Alcohol Counselor. Looking to apply my healthcare expertise, problem-solving skills, and compassion in a role that supports individuals on their recovery journey. Skilled Clinical Technician with background in performing diagnostic tests, administering medication under supervision, and maintaining patient records. Strengths include a comprehensive understanding of medical terminology, strong interpersonal skills for patient interaction, and the ability to work collaboratively in cross-functional teams.. Demonstrated impact by enhancing lab procedures, ensuring the accuracy of test results, and providing critical support to healthcare professionals, and known for commitment to patient care and adherence to safety protocols.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Clinical Technician (RADT)
Akua Behavioral Health
Rancho Cordova, CA
02.2025 - Current
- Client Care: Support patients struggling with addiction and mental health disorders through daily activities and programming, appointments, and crisis intervention
- Safety Checks: Conduct regular physical checks on all patients within care (a.k.a
- "rounds")
- Intakes & Discharges: Play a leading role in patient intakes and discharges from the treatment facility, ensuring all clients feel comfortable and welcome
- Medication Observation: Monitor and document client self-administration of medications by the facility's policies and procedures
- Group Facilitation: Participate in and facilitate applicable group sessions (e.g., life skills, art therapy, outings, etc.)
- Documentation: Take all required notes in the company's electronic medical record system (KIPU)
Medical Claims Examiner
PORAC IBT Through IOS Staffing
Sacramento, CA
11.2023 - 03.2024
- Analyzed and processed medical claims, adhering to established guidelines and ensuring accuracy in coding with ICD-10, CPT, and HCPCS
- Investigated and resolved discrepancies in medical claims by engaging with healthcare providers and insurers, ensuring regulatory compliance with HIPAA and CMS
- Collaborated with cross-functional teams to address and rectify claim issues, maintaining meticulous records of claims activities
- Contributed to the development of process improvements, enhancing the efficiency of claim processing workflows
Medical Claims Examiner
Whollberg Michaelson/Centene
Sacramento, CA
06.2023 - 09.2023
- Assessed insurance claims to verify policy coverage and determined settlement amounts, ensuring adherence to company guidelines and procedures
- Processed claim payments and managed reserve allocations for cost control, while facilitating timely fund disbursements
- Coordinated investigative efforts for complex claims, collaborating with legal and medical professionals to resolve claimant issues effectively
Claims Examiner
MAXIMUS / RANDSTAD STAFFING
Sacramento, CA
11.2021 - 04.2023
- Conducted comprehensive analysis of claim information to identify and resolve outstanding issues, ensuring adherence to UI Code, policies, and procedures
- Facilitated clear and effective communication with claimants and employers to gather necessary information, updating records with detailed notes on all contacts and actions taken
- Collaborated with subject matter experts to enhance understanding of intricate issues, escalating complex cases to supervisors for further review
Service Desk Tier 3
CGI Group
Sacramento, CA
08.2019 - 01.2021
- Managed critical support inquiries, providing assistance and information to IHSS and WPCS providers, ensuring adherence to program policies and confidentiality requirements
- Directed providers to appropriate county resources, tailoring referrals to meet individual customer needs effectively
- Uphold stringent security and privacy protocols, consistently aligning with PHI and HIPAA standards in all customer interactions
Accounts Receivable Clerk
Optimum 360/Robert Half Recruiting
Sacramento, CA
04.2019 - 07.2019
- Posted and reconciled payments from insurance companies and patients, ensuring accurate reflection in patient account ledgers
- Utilized electronic billing and patient accounting systems to extract payment data for processing and verification
- Analyzed and interpreted EOBs, confirmed contractual write-offs, and rectified discrepancies in payment applications to uphold financial integrity
Medical Claims Examiner
Healthnet / Centene Wolborg Michaelson
Rancho Cordova, CA
11.2017 - 01.2019
- Adjudicated medical claims with precision, ensuring compliance with quality standards and departmental guidelines
- Specialized in claim corrections, effectively rectifying pending, approved, and denied claims to guarantee accurate payments and adherence to timelines
- Uphold a flawless accuracy record, with all audited claims meeting the stringent requirements of the Audit Department
Member Care Representative I
Golden 1 Credit Union
Sacramento, CA
10.2015 - 04.2017
- Addressed delinquent and negative account issues through effective communication with members, ensuring timely resolution and reduction of non-performing assets
- Negotiated payment arrangements for past-due accounts utilizing high-volume inbound and outbound call strategies to maintain account performance
- Uphold a comprehensive knowledge of state and federal compliance regulations, including bank secrecy and anti-money laundering laws, to support internal investigations and resolution of account discrepancies
Account Manager
Homejoy
Sacramento, CA
07.2014 - 07.2015
- Managed customer account billing, processing financial documentation and maintaining communication to resolve outstanding debts and keep accounts current
- Collaborated with supervisors to enhance the appointment fulfillment process, contributing to the development and adoption of an automated system to improve efficiency and customer satisfaction
Customer Solution Technician
Sprint
Sacramento, CA
09.2013 - 07.2014
- Diagnosed and resolved mechanical, hardware, software, and system failures using established procedures to minimize customer downtime
- Managed complex technical support assignments, employing independent action and initiative to effectively address customer service issues
Data Analyst/Conversion Specialist
Lexis Nexis
Sacramento, CA
09.2012 - 09.2013
- Analyzed and improved data management processes, ensuring the accuracy and timeliness of legal document acquisition and XML conversion, while consistently meeting daily deadlines
- Collaborated with team members in design and execution of test procedures, contributing to the validation and quality assurance of primary law content
Office Assistant
Department of Social Services
Sacramento, CA
02.2008 - 03.2009
- Coordinated client orientations and exams, while managing the processing of facility license applications, enhancing the accuracy of needs assessments
- Improved file system efficiency by developing a streamlined approach adopted by management and served as a lead investigator for client and employee complaints, ensuring effective internal communication and resolution
Collection Specialist
Nationwide Credit
Sacramento, CA
05.2006 - 01.2007
- Managed client documentation and maintained data accuracy for credit card and mortgage payment processing, ensuring compliance with federal and state debt collection laws
- Facilitated client payment arrangements and handled the initiation of repossession proceedings, transferring accounts to specialized legal practices for further debt collection measures
Motor Vehicle Representative
Department of Motor Vehicles
Sacramento, CA
04.2001 - 04.2006
- Managed customer inquiries and provided clarifications on licensing, registration, and titling processes, ensuring compliance with established statutes and policies
- Processed a high volume of transactions, including fee computation and collection, ensuring accuracy in financial records and customer satisfaction
- Maintained proficiency in using electronic databases for information retrieval and data entry, contributing to the efficient operation of service counter activities
Education
College -
Cosumnes River College
Sacramento, CA03-2026
Some College (No Degree) - Business Management
Lincoln University
Lincoln, PASome College (No Degree) - Business Management
Sacramento City College
Sacramento, CASkills
- SharePoint
- ICD coding
- Advanced Knowledge of Quantum Choice
- Dispute Resolution
- Hospitality
- Mental health counseling
- Zendesk
- Team Building and Employee Training
- Salesforce
- Anatomy knowledge
- Microsoft Outlook
- Revenue cycle management
- Outbound calling
- Research
- ICD-10
- Organizational skills
- Appointment scheduling
- Contracts
- Knowledge of Mac and PC Operating System
- Initiative and Problem-Solving Abilities
- Insurance verification
- Microsoft Powerpoint
- Strong Analytical and Conflict Resolution
- Knowledge of Zendesk, Talkdesk and Front Software
- Interpersonal and Technical Skills
- Linux
- Content management systems
- Management
- Home & community care
- Epic
- Documentation review
- Microsoft Access
- ERP systems
- Telemarketing
- Pricing
- Accounting software
- Advanced Knowledge of CRM
- Cash handling
- Ophthalmology
- Writing skills
- Project management
- Care plans
- Google Suite
- Account Management
- DME
- Advanced Knowledge of Google Software (Docs, Sheets, Slides, Forms)
- 10 key typing
- HCPCS
- Operating systems
- Management and Leadership Abilities
- Advanced Knowledge of Salesforce
- Basic math
- Microsoft Word
- IVR
- AI
- Medical collection
- B2B
- Customer Experience, Satisfaction and Retention
- Addiction counseling
- Authentication
- Law office
- Driving
- Natural Ability to Work Both Individually or as Part of a Team
- IOS
- ICD-9
- Fair Housing regulations
- Medical administrative support
- Transportation management systems
- Medicare
- Windows
- Microsoft Excel
- Medical office experience
- Strong Communication Skills
- Time management
- Data Entry and Records Management
- Attention to detail
Certification
- CPR Certification
- Certified Professional Coder
Timeline
Clinical Technician (RADT)
Akua Behavioral Health
02.2025 - Current
Medical Claims Examiner
PORAC IBT Through IOS Staffing
11.2023 - 03.2024
Medical Claims Examiner
Whollberg Michaelson/Centene
06.2023 - 09.2023
Claims Examiner
MAXIMUS / RANDSTAD STAFFING
11.2021 - 04.2023
Service Desk Tier 3
CGI Group
08.2019 - 01.2021
Accounts Receivable Clerk
Optimum 360/Robert Half Recruiting
04.2019 - 07.2019
Medical Claims Examiner
Healthnet / Centene Wolborg Michaelson
11.2017 - 01.2019
Member Care Representative I
Golden 1 Credit Union
10.2015 - 04.2017
Account Manager
Homejoy
07.2014 - 07.2015
Customer Solution Technician
Sprint
09.2013 - 07.2014
Data Analyst/Conversion Specialist
Lexis Nexis
09.2012 - 09.2013
Office Assistant
Department of Social Services
02.2008 - 03.2009
Collection Specialist
Nationwide Credit
05.2006 - 01.2007
Motor Vehicle Representative
Department of Motor Vehicles
04.2001 - 04.2006
College -
Cosumnes River College
Some College (No Degree) - Business Management
Lincoln University
Some College (No Degree) - Business Management
Sacramento City College
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