Laura Mares
Riverside,CA
Summary
Driven professional with a proven track record at Altais, adept in claims review and ensuring accuracy and precision. Excelled in processing high volumes of medical claims efficiently, demonstrating exceptional problem-solving skills in claim denial resolution. Skilled in HIPAA compliance, consistently achieving prompt and accurate claim processing outcomes.
Overview
11
11
years of professional experience
Work History
Claims Processor
Altais
02.2023 - 10.2023
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
Provider Dispute Resolution Specialist
Optum
11.2018 - 08.2022
- Achieved successful dispute resolutions through active listening and empathetic communication skills.
- Provided extensive support for claims throughout the dispute resolution process.
- Maintained detailed case records, enabling efficient tracking of progress and comprehensive reporting to upper management.
- Coordinated closely with other departments within the organization for seamless collaboration during multifaceted dispute resolutions, ensuring all relevant parties were informed and engaged throughout the process.
Medical Claims Examiner
NAMM Part Of Optum
02.2013 - 11.2018
- Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
- Assisted in the training and onboarding of new team members, sharing knowledge and best practices to ensure their success.
- Collaborated with healthcare providers to obtain necessary medical records, ensuring timely and accurate claim adjudication.
- Supported team members during periods of high workload, providing guidance on challenging cases or offering assistance when needed.
Education
Medical Insurance Billing
American Career College
Ontario, CA06.2009
High School Diploma -
La Sierra High School
Riverside, CA06.1994
Skills
- Policy Interpretation
- Insurance claims processing
- Coordination of benefits
- ICD-9 and CPT coding
Languages
Spanish
Native or Bilingual
Timeline
Claims Processor
Altais
02.2023 - 10.2023
Provider Dispute Resolution Specialist
Optum
11.2018 - 08.2022
Medical Claims Examiner
NAMM Part Of Optum
02.2013 - 11.2018
Medical Insurance Billing
American Career College
High School Diploma -
La Sierra High School
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