Lacey Duran
Rio Rancho
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
11
11
years of professional experience
Work History
Health Coordinator
Blue Cross Blue Shield of NM
02.2023 - Current
- Informed and educated members about medical management programs through effective outreach.
- Conducted research and performed data entry to support departmental operations.
- Responded to member inquiries, ensuring timely and accurate information delivery.
- Assisted clinicians with provider and member activities in Medical Management department.
- Maintained confidentiality and protected Personally Identifiable Information (PII) in daily tasks.
- Processed inpatient stays for members enrolled in Chicago health plan.
- Created new inpatient cases in Smart Utilization Management Program (SUM) and Guiding Care (GC).
- Identified errors from worklist and updated error log to enhance accuracy.
Claims Specialist
Presbyterian Health Plan
02.2019 - 02.2023
- Reviewed billing information for accuracy and compliance with regulations.
- Investigated discrepancies to ensure correct documentation.
- Verified claimant documentation and related materials.
- Applied knowledge of medical terminology and pharmaceuticals during claims assessment.
- Settled claims following established company guidelines.
- Analyzed and resolved health service-related claims efficiently.
- Maintained confidentiality of sensitive information throughout the claims process.
- Supported new employees in adapting to system changes and procedures.
Provider Relations Specialist
Conduent (formerly Xerox Services)
01.2017 - 02.2019
- Delivered status updates to providers regarding claim progress.
- Resolved inquiries from providers to enhance communication efficiency.
- Confirmed eligibility of claims to ensure compliance with guidelines.
- Verified provider enrollment through calls to maintain accurate records.
- Trained new staff through shadowing and side-by-side instruction for effective onboarding.
Claims Specialist
Conduent (formerly Xerox Services)
11.2015 - 01.2017
- Processed Medicaid provider claims efficiently and accurately.
- Executed mass claims adjustments to ensure compliance.
- Maintained comprehensive medical records for Medicaid members.
- Resolved discrepancies and issues related to claims promptly.
- Trained new staff through shadowing and side-by-side methods.
Front Desk Cashier
Kmart
11.2014 - 01.2017
- Delivered exceptional customer service across multiple teams.
- Maintained clear and safe environment for front desk operations and registers.
- Processed returns, layaway payments, online orders, and purchases efficiently.
Call Center Representative
Conduent (formerly Xerox Services)
08.2015 - 11.2015
- Facilitated Medicaid eligibility responses for clients efficiently.
- Assisted clients in transitioning to new MCOs as needed.
- Supported clients with Centennial Care Coverage inquiries and applications.
- Contributed to special projects assigned by state clients to enhance service delivery.
- Trained new staff through hands-on shadowing and direct collaboration.
Education
Bachelor of Science - Business
University of Phoenix
12.2025
Associate of Arts - Business Fundamentals
University of Phoenix
03.2025
High School Graduate -
Sandia High School
Albuquerque, NM05-2011
General Studies -
CNM
Albuquerque, NMSkills
- Customer support and service
- Claims management
- Research proficiency
- Effective communication
- Problem solving
- Multitasking
- Dependability and reliability
- Organizational skills
- Adaptability to change
- Goal attainment
- Technical proficiency with computers
- Detail-oriented approach
References
- Kim Shipman, Business Analyst, BCBS, (505) 203-2256
- Wendy Christian, Healthcare Coordinator, BCBS, (505) 261-4909
- Tammy Strickland, Medicaid Manager, Presbyterian Health Plan, (505) 803-1976
Timeline
Health Coordinator
Blue Cross Blue Shield of NM
02.2023 - Current
Claims Specialist
Presbyterian Health Plan
02.2019 - 02.2023
Provider Relations Specialist
Conduent (formerly Xerox Services)
01.2017 - 02.2019
Claims Specialist
Conduent (formerly Xerox Services)
11.2015 - 01.2017
Call Center Representative
Conduent (formerly Xerox Services)
08.2015 - 11.2015
Front Desk Cashier
Kmart
11.2014 - 01.2017
Bachelor of Science - Business
University of Phoenix
Associate of Arts - Business Fundamentals
University of Phoenix
High School Graduate -
Sandia High School
General Studies -
CNM