Kimberly Sanchez
Sacramento,CA
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience. Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking opportunities to expand skills while facilitating company growth. Responsible and motivated employee. I offer excellent technical abilities with software and applications, ability to handle challenging work, and excellent time management skills.
Overview
8
8
years of professional experience
Work History
Patient Account Rep III
Macman HealthCare Services (Medusind)
05.2023 - Current
- Month End: Balance all financial payments (Medi-Cal and Commercial payers)
- Generate month-end financial report and pivot to reflect check numbers and totals
- Dentrix Hard Close
- Denial Management & Accounts Receivable: Review Medi-Cal denials weekly for resolution
- Download RADs, format for payment posters
- Review Commercial payer EOBs for denials and delegate to staff for resolution
- Work longest aged accounts to resolve before denied due to timeliness
- Oversee 1 other staff on account who is assigned to Commercial accounts
- Claim Printing: Review and Print claims
- Retrieve necessary attachments
- Additional Tasks: Download RAD weekly, provide to IT for conversion and formatting
- Create pre-authorizations upon the request of client
- Attend all client meetings
- Primary person of contact for client for billing related matters.
Patient Access Lead
Macman HealthCare Services (Medusind)
03.2022 - 05.2023
- Oversight of 2 call centers
- Monitor call queue to ensure adequate coverage
- Monitor progress to ensure production goals are met
- Monitor call escalation log to ensure patient calls are returned according to policy
- Generate month end call production reports and prepare data for client call presentation
- Provide next level support
- Primary person of contact for client
- Additional Tasks: Conduct staff one-on-one’s
- Provide troubleshooting for client access and company systems
- Submit requests to client for new hire network and system access
- New Hire walk through of systems to ensure access, follow-up with client if needed
- Provide new hires access to essential SharePoint folders designated for UHC documents.
Patient Access Rep II
Macman HealthCare Services (Medusind)
07.2021 - 03.2022
- Consistently respond to all incoming calls. Meet established quality and productivity standards for self and for the team.
- Assist patients with clarification, correction and resolution of their accounts for various medical services via inbound and outbound telephone calls.
- Accurately obtain via, telephone, the required financial and insurance information from the patient, patient’s representative, or physician’s office.
- Communicate insurance coverage details to patients and inform the patient/guarantor prior to the service date regarding payment expectations related to co-payments, co-insurance, and/or deductible amounts.
- Resolve Billing related Queries and update insurance. Provide assistance to patients with questions regarding billing or open accounts.
- Attempt to collect patient payments during initial phone contact in order to alleviate the amount of effort.
- Inform Department Director, Supervisor or Team Lead of potential problem accounts or additional requirements for reimbursement to receive direction on how to resolve situations.
- Must be able to handle the pressure of answering patient/client telephone calls and accurately process correspondence within department goals.
- Ability to exhibit a heightened sense of listening to patient concerns which translates into successful problem-solving and conflict resolution.
- Maintain the strictest confidentiality regarding patients according to policies and procedures.
- Must be able to multi-task in a fast-paced environment and quickly adapt to change.
- Contribute to team effort by accomplishing related results as needed.
- Perform other duties as assigned.
Patient Access Rep
Macman HealthCare Services (Medusind)
03.2021 - 07.2021
- Consistently respond to all incoming calls. Meet established quality and productivity standards for self and for the team.
- Assist patients with clarification, correction and resolution of their accounts for various medical services via inbound and outbound telephone calls.
- Accurately obtain via, telephone, the required financial and insurance information from the patient, patient’s representative, or physician’s office.
- Communicate insurance coverage details to patients and inform the patient/guarantor prior to the service date regarding payment expectations related to co-payments, co-insurance, and/or deductible amounts.
- Resolve Billing related Queries and update insurance. Provide assistance to patients with questions regarding billing or open accounts.
- Attempt to collect patient payments during initial phone contact in order to alleviate the amount of effort.
- Inform Department Director, Supervisor or Team Lead of potential problem accounts or additional requirements for reimbursement to receive direction on how to resolve situations.
- Must be able to handle the pressure of answering patient/client telephone calls and accurately process correspondence within department goals.
- Ability to exhibit a heightened sense of listening to patient concerns which translates into successful problem-solving and conflict resolution.
- Maintain the strictest confidentiality regarding patients according to policies and procedures.
- Must be able to multi-task in a fast-paced environment and quickly adapt to change.
- Contribute to team effort by accomplishing related results as needed.
Starbucks Barista
Target
10.2018 - 08.2019
- Assisted guests with ordering drinks as well as preparing their drinks
- Made sure all orders were correctly made and handed to guests.
Call Center Representative
Covered California
11.2017 - 09.2018
- Handled inbound calls
- Assured that consumers' health insurance was active, verified and reassured them if any documents were requested to have their health plan remain active.
- Also performed Manual Workstream.
Team Member
KFC
02.2016 - 09.2017
- In charge of cash register
- Made sure all sales were properly made
- Verified that all food products were at the correct temperature to properly distribute to consumers.
Education
High School Diploma -
Florin High School
Sacramento05-2017
Skills
- PowerPoint, Excel, Word
- EPM System's, ( AthenaOne, Athena Dental, Dentrix, Nextgen, ECW)
- Team Collaboration
- Well organized
- Competitive
- Fast learner
- Friendly
- Dental Billing
- Insurance Verification
- Insurance Billing
- Payment Processing
- Collections experience
- Applications
- HIPAA understanding\Compliance
- Regulatory Compliance
- Bookkeeping procedures
- Follow-up skills
- Medical and Dental terminology knowledge
- Administrative Support
- Patient Care
Languages
- English
- Spanish
References
MedusindMedusindMedusindMedusindMacmanMacmanMacmanMacman
- Micheal Childress, (916)207-6203, Supervisor at Covered California and Maximus
- Nancy Sanchez, (808)265-5056, Coworker at Maximus
- Jesus Aguilera, (916)856-2463, Friend
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Patient Account Rep III
Macman HealthCare Services (Medusind)
05.2023 - Current
Patient Access Lead
Macman HealthCare Services (Medusind)
03.2022 - 05.2023
Patient Access Rep II
Macman HealthCare Services (Medusind)
07.2021 - 03.2022
Patient Access Rep
Macman HealthCare Services (Medusind)
03.2021 - 07.2021
Starbucks Barista
Target
10.2018 - 08.2019
Call Center Representative
Covered California
11.2017 - 09.2018
Team Member
KFC
02.2016 - 09.2017
High School Diploma -
Florin High School
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