Karen Jael Santiago

Utilized specialized software to process incoming claims, enter data and generate reports.

• Managed workload and priorities to meet claims processing meet deadlines.
• Reviewed applications and supporting documents to verify claims eligibility and accuracy.
• Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
• Followed up with customers on unresolved issues.
• Monitored claims processing trends to identify potential areas of improvement.
• Checked documentation for accuracy and validity on updated systems.
• Coordinated with contracting department to resolve payer issues.

• Coordinated, monitored, assigned, and documented patient and clinical care activities.
• Devised and implemented clinical protocols to ensure high-quality patient care.
• Supervised and managed daily activities of clinical team consisting of 0 physicians, nurses, and support staff.
• Presented feedback on current and new procedures at weekly clinical meetings.
• Organized systems for tracking patient records to improve ease of retrieval.
• Developed and adjusted work schedules for nurses staff.
• Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
• Discussed medical histories with patients in effort to provide most effective medical advice.
• Monitored and inspected staff processes to eliminate hazards posed for both residents and staff while ensuring continuous compliance with regulations.
• Ordered all pharmacy supplies and kept check on inventory levels.
• Spearheaded and implemented new projects to expand scope of engagement.
• Communicated with patients, ensuring that medical information was kept private.
• Documented vital signs and health history for patients in clinic and hospital environments.