Kerry Sandoval
Albuquerque,NM
Summary
Experienced medical Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 5 years of experience and willingness to take on any challenge.
Overview
10
10
years of professional experience
Work History
Coordination of Benefits Specialist
Presbyterian Health Plan
Albuquerque, NM
12.2022 - Current
- Collaborated with healthcare providers and insurance companies for efficient claim processing and prompt reimbursements.
- Coordinated cross-departmental efforts in complex cases involving multiple specialists or facilities to ensure seamless insurance coverage for patients throughout their care journey.
- Enhanced patient satisfaction with timely and accurate insurance verifications, ensuring seamless access to healthcare services.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
Medical Claims Specialist
Presbyterian Health Plan
Albuquerque, NM
11.2019 - 12.2022
- Submitted electronic/paper claims documentation for timely filing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Processing and data enter presbyterian transplant claims
- Data entering medical and hospital claims into processing system
Claims Specialist
UnitedHealthcare
Albuquerque, NM
03.2016 - 11.2019
- Medical and hospital claims processing in a timely manner to meet regulations
- Medical and hospital claims data entry
- Processing claims for multiple state and lines of business
- Working with SME on special claims projects
- Worked on and created macros for faster and more efficient claims processing
- Distributed excel worksheets daily to claims processors
Customer Service Representative
AT&T
Rio Rancho, NM
02.2016 - 03.2016
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Answered constant flow of customer calls with minimal wait times.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Assisted customers with setting appointments, special order requests, and arranging merchandise pick-up.
- Recommended products to customers, thoroughly explaining details.
- Fielded customer questions regarding available merchandise, sales, current prices and upcoming company changes.
- Provided information regarding charge accounts and loyalty programs.
- Used company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
Advanced Technical Support Specialist
Apple
Rio Rancho, NM
02.2015 - 02.2016
- Broke down and evaluated user problems, using test scripts, personal expertise and probing questions.
- Removed malware, ransomware and other threats from laptops and desktop systems.
- Troubleshoot apple and mac products
- Helped Customers updating to new IOS or new OS systems
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Worked flexible hours; night, weekend, and holiday shifts.
- Carried out day-day-day duties accurately and efficiently.
Education
No Degree - Secretarial Studies And Office Administration
Albuquerque Job Corps Center
Albuqueque, NM10.2011
GED -
Albuquerque Job Corps Center
Albuqueque, NM10.2011
Skills
- ICD-10 Coding
- New Policies Processing
- Reading Comprehension
- Insurance Policy Coverage Knowledge
- Critical Thinking
- Health Insurance Industry Knowledge
- Data Entry Accuracy
- Reviewing Patient Information
- Microsoft Excel
Accomplishments
- Collaborated with 1 other team member to process all ASO transplant and transplant travel claims.
Timeline
Coordination of Benefits Specialist
Presbyterian Health Plan
12.2022 - Current
Medical Claims Specialist
Presbyterian Health Plan
11.2019 - 12.2022
Claims Specialist
UnitedHealthcare
03.2016 - 11.2019
Customer Service Representative
AT&T
02.2016 - 03.2016
Advanced Technical Support Specialist
Apple
02.2015 - 02.2016
No Degree - Secretarial Studies And Office Administration
Albuquerque Job Corps Center
GED -
Albuquerque Job Corps Center