Leonor Espinoza

• Reviewed, processed, and adjusted medical claims for Medicaid recipients through Molina and CareSource
• Analyze documentation (medical records, policy information)
• Reviewed and processed complex claims, ensuring timely resolution of disputes and inquiries.
• Analyze claims for accuracy, adhering to regulatory standards and organizational policies.
• Maintain compliance with regulations and meet production/accuracy targets
• Monitor and document claim status, request missing info, submit disputes
• Post denials and act for resolution (adjustments, disputes)
• Collect, organize, and analyze documentation (ex. medical records, policy info)
• Reviewed and processed complex claims, ensuring timely resolution of disputes/inquiries.
• Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process
• Collaborated in cross-functional team meetings to address claims management challenges and develop effective solutions
• Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively
• Reviewed provider statements for accuracy and completeness.
• Reviewed insurance policies and SOPs to determine coverage levels and claim approval/denial decisions
• Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently
• Contributed to a positive work environment through active participation in team meetings and to stay current on developments/updates/SOPs within the field of claims examining/adjusting

• Assisted in administrative tasks, ensuring efficient office operations and effective communication among departments
• Kept office supplies well organized and sufficiently stocked
• Supported staff on special assignments and projects
• Processed outgoing mail and packages according to established procedures
• Maintained office supplies
• Assisted in delivering documents, forms and supplies to the departments around campus
• Provided support for the print shop and mail services department
• Collaborated with print shop clerk to create internal documents and forms
• Assisted the print shop supervisor in collating, punching and binding manuals for college use
• Provided daily assistant tasks for the coordinator

Nationally Registered Certified Medical Assistant and Nationally Registered Certified Coding Specialist – National Association for Health Professionals – Certificate # 177224

Nationally Registered Certified Medical Assistant and Nationally Registered Certified Coding Specialist – National Association for Health Professionals – Certificate # 177224