Karen Martinez
Westminster,CO
Summary
To secure a position as a Claims Integrity and Exception Specialist. Providing adaptability, a strong sense of teamwork, and dedication to excellence.
Overview
21
21
years of professional experience
Work History
Billing Specialist for Medicare and Medicaid Insurance
Zynex Medical, an Altivera Medical Company
Denver, CO
06.2026 - Current
- Reviews medical records and prescriptions for completeness and validity per insurance and company guidelines.
- Maintained accurate and detailed records of patient accounts, ensuring data integrity and confidentiality.
- Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
- Follows established criteria and checklists per insurance and industry standards
- Processed and validated insurance claims for accuracy and compliance with company policies.
- Analyzed billing discrepancies to resolve issues and ensure timely payments.
Senior Patient Enrollment Specialist for Medicare and Medicaid Insurance
Denver, CO
12.2023 - 06.2026
- Handled a high volume of inbound and outbound calls from patients with DME prescriptions.
- Handled and resolved escalated patient’s claims.
- Managed patient enrollment processes, ensuring compliance with regulatory standards and internal policies.
- Maintained accurate records and provided detailed and professional notes in patient files.
- Completed cross training with Medicaid and Medicare Billing team and performed billing tasks as assigned.
Caregiver/Personal Assistant
Self Employed
Denver, CO
03.2020 - 08.2023
- Accompanied clients to medical appointments and picked up prescriptions.
- Assisted clients with filling out important paperwork and replying to emails.
- Managed medication schedules and reminders, promoting adherence to prescribed health regimens.
- Provided personalized care and assistance to clients, ensuring comfort and safety in daily activities.
- Cleaned house, ran errands, managed laundry, and completed weekly grocery shopping.
Claims Management Rep/Purchasing Agent
2-10 Home Buyers Warranty
Aurora, CO
04.2017 - 10.2019
- Received diagnosis for home warranty claims from contractors and ordered equipment and parts as needed.
- Demonstrated an elevated level of empathy, sensitivity, and knowledge, to alleviate and resolve customer complaints and escalations.
- Reviewed and resolved homeowner warranty requests including research, outreach, follow up and resolution.
- Researched, analyzed, and made eligibility and coverage determinations, based on warranty terms and conditions and limits of liability.
- Authorized payment and approvals on claims.
- Enhanced customer satisfaction levels by addressing concerns promptly and implementing targeted solutions.
Human Resources Assistant
Aims Community College
Greeley, CO
02.2013 - 05.2014
- Handling employees’ and applicants’ classified information and documents adhering to HIPPA regulations and guidelines.
- Accessed and inputted employee information into the Banner Employee Database.
- Provided administrative support for the Human Resource department.
- Efficiently managed personnel files, maintaining confidentiality while keeping records up-to-date and organized.
- Filed paperwork, sorted, and delivered mail and maintained office organization.
- Answered and redirected incoming phone calls for office.
Customer Service Representative
Asurion
Evans, CO
08.2005 - 09.2010
- Processed cell phone insurance claims for Sprint and AT&T customers.
- Handled over 60 inbound calls per day.
- Cross trained representative, responsible for handling Sprint and AT&T accounts.
- Ensured company policies and procedures were followed for both AT&T and Sprint.
- Met and exceeded performance metrics required.
- Resolved customer inquiries through effective communication and problem-solving techniques.
Skills
- Billing systems and software
- Insurance verification
- Analytical thinking
- Order Validation
- Insurance claim processing
- Attention to detail
Timeline
Billing Specialist for Medicare and Medicaid Insurance
Zynex Medical, an Altivera Medical Company
06.2026 - Current
Senior Patient Enrollment Specialist for Medicare and Medicaid Insurance
12.2023 - 06.2026
Caregiver/Personal Assistant
Self Employed
03.2020 - 08.2023
Claims Management Rep/Purchasing Agent
2-10 Home Buyers Warranty
04.2017 - 10.2019
Human Resources Assistant
Aims Community College
02.2013 - 05.2014
Customer Service Representative
Asurion
08.2005 - 09.2010