Job Search Status
Open to workDesired start date: Open to discussion
Open To Work
Kassandra Calleros-Martinez
Chino,CA
Work Preference
Summary
Detail-oriented Denial Specialist with extensive experience in insurance resolution and claims analysis. Proven ability to enhance claims accuracy and streamline processes, ensuring timely reimbursement and effective communication with insurance representatives.
Overview
11
11
years of professional experience
Work History
Denial Specialist
Adventist Health System
Roseville, California
09.2025 - Current
- Reviewed denial claims to identify and correct errors, enhancing claims accuracy.
- Communicated with insurance representatives to resolve claim issues effectively.
- Analyzed claim data to determine trends in denials and disputes.
- Identified discrepancies in patient information, provider information, or coding accuracy during the denial process
- Ensured accurate billing and collections for 1500 and UB04 claims across multiple clinic types, streamlining processes.
- Collaborated with Medicare, Medi-Cal, commercial, workers compensation, and VA payers to resolve claim issues.
- Worked remotely, managing tasks efficiently
Credits and Collections Specialist
R1RCM / Providence Healthcare
Murray, Utah
02.2024 - 09.2025
- Reviewed transaction histories to confirm refund eligibility, supporting customer satisfaction.
- Processed customer refund requests, ensuring accuracy and timeliness.
- Trained new team members on refund processes and policies, enhancing team knowledge.
- Worked remotely, managing tasks efficiently
Insurance Follow-Up Representative
Medix Staffing Solutions Inc.
Los Angeles, California
03.2023 - 09.2023
- Coordinated follow-up on insurance claims with healthcare providers and payers to facilitate timely reimbursement.
- Conducted follow-up on professional billing and UB04 claims, ensuring accurate processing and resolution of outstanding issues.
- Submitted appeals for all denial types, including timely filing, additional information requests, underpayments, and medical necessity, to recover owed funds.
- Resolved account discrepancies by applying adjustments after confirming reimbursements.
- Worked remotely, managing tasks efficiently
Sr. Medicare Insurance collector
Prime Healthcare
Ontario, California
02.2020 - 03.2023
- Followed up with insurance companies on unpaid or rejected claims, ensuring timely resolution and payment.
- Reviewed and reconciled payment discrepancies to ensure accurate records.
- Coordinated with healthcare providers to resolve billing discrepancies, enhancing overall accuracy of claims processing.
- Utilized billing software to track and manage claim statuses effectively.
- Analyzed claims data to identify trends and improve processes.
- Compiled weekly and monthly reports on performance metrics, providing insights for revenue cycle improvements.
- Educated staff on revenue cycle best practices and compliance standards.
- Trained new staff on cash posting procedures and system usage guidelines.
Patient Account Representative
Emanate Health
Covina, California
02.2016 - 01.2020
- Worked closely with insurance companies to obtain authorization for services rendered.
- Processed insurance claims using advanced medical billing software.
- Reviewed EOB statements for accuracy against provider charges, ensuring correct billing and minimizing discrepancies.
- Submitted appeals for denied claims based on thorough research, advocating for patients' rights to appropriate coverage.
- Educated patients on payment options and insurance coverage, enhancing their understanding of financial responsibilities.
- Assisted in training new staff on billing procedures and systems.
- Maintained detailed notes on all patient interactions for future reference purposes.
Insurance Collector
California Business Bureau Inc.
Monrovia, California
11.2014 - 02.2016
- Managed UB04 facility collections for insurance accounts, ensuring timely recovery of outstanding balances.
- Oversaw collections process for overdue insurance accounts, streamlining follow-up procedures to enhance resolution rates.
- Collaborated with insurance agents to resolve account discrepancies, improving overall customer satisfaction.
- Submitted corrected claims and reconsiderations with supporting documentation.
Education
CCS -allied Health - CCS
Loma Linda University
Loma Linda, CAHigh School Diploma -
Nogales High School
La Puente, CASkills
- Denial management
- UB04 collections 15 years
- Professional 1500 2 years
- Insurance resolution
- Appeals processing
- Payment posting
- EPIC, MEDITECH, CERNER, Microsoft
- Excel pivot reports
- Critical thinking
- Daily productivity 30-40
- Training and mentoring
Languages
Spanish
Native/ Bilingual
Timeline
Denial Specialist
Adventist Health System
09.2025 - Current
Credits and Collections Specialist
R1RCM / Providence Healthcare
02.2024 - 09.2025
Insurance Follow-Up Representative
Medix Staffing Solutions Inc.
03.2023 - 09.2023
Sr. Medicare Insurance collector
Prime Healthcare
02.2020 - 03.2023
Patient Account Representative
Emanate Health
02.2016 - 01.2020
Insurance Collector
California Business Bureau Inc.
11.2014 - 02.2016
CCS -allied Health - CCS
Loma Linda University
High School Diploma -
Nogales High School