Lesley Solorzano
Dallas,TX
Summary
Dedicated and driven Cloud Computing student with a passion for technology and innovation. Currently pursuing an Associate of Science (A.S.) degree in Cloud Computing, with coursework including Machine Learning, Data Structures, Algorithms, Artificial Intelligence, and Database Management Systems. Eager to apply skills and knowledge in real-world settings to contribute to meaningful advancements. Seeking employment opportunities to develop professionally and take on new challenges.
Overview
7
7
years of professional experience
1
1
Certification
1
1
year of post-secondary education
Work History
Claims Adjuster
WebTPA
Irving, TX
05.2020 - 01.2024
- Coordinated the activities related to claims investigation, settlement negotiation, medical record interpretation, response to Department of Insurance Complaints,and approval of payments to claimants and providers.
- Ensured accuracy of financial records by conducting overpayment reviews and recovery, rectifying discrepancies in patient and service provider profiles.
- Effectively processed medical and dental claims through accurate coding, adjudication, and research when required.
- Investigated insurance claims, assessed coverage and liability, prepared reports, and made recommendations on claim payment or denial.
- Researched relevant laws, regulations, legal decisions and precedents to determine appropriate course of action.
- Interpreted policy language to determine coverage for insureds under various lines of business.
- Maintained accurate documentation of all claim activity within designated system.
- Adhered strictly to departmental guidelines; ensured that all activities were compliant with applicable state laws.
- Attended continuing education classes in order to stay abreast of changes in industry standards.
- Evaluated performance metrics regularly; suggested modifications where necessary for increased efficiency.
- Negotiated and settled claims according to information presented through reports, research and data verification.
- Reviewed data to verify validity of claims and determine case management actions.
Medical Representative
IKS Health
Coppell, TX
01.2018 - 05.2020
- Managed smooth and effective communication among physicians, patients, families and staff.
- Reviewed clinical data provided by employer to maintain latest industry knowledge and share with customers.
- Updated customer information in CRM database daily to document latest interactions and activity.
- Followed up with customer to identify and resolve service, account or technical issues and maintain satisfaction.
- Responded promptly to customer calls and emails regarding product issues and complaints.
- Provided technical support to physicians by answering questions about product features, benefits, and uses.
Dental Assistant
Dart Dental
Plano, TX
11.2016 - 01.2018
- Assisted dentist in providing dental treatment to patients, including taking patient medical histories and vital signs.
- Prepared dental materials such as amalgam, composite resin, impression material and cements for use by the dentist.
- Provided chair-side assistance during dental procedures, including passing instruments to the dentist and holding suction devices.
- Educated patients on proper oral hygiene techniques and habits.
- Maintained a neat, clean and organized environment throughout the office.
- Performed administrative duties such as scheduling appointments, answering telephones and updating patient records.
- Took digital X-rays of teeth using radiographic equipment.
- Sterilized instruments according to established guidelines and protocols.
- Kept accurate records of dental treatments provided for each patient's visit.
- Fabricated temporary crowns or bridges from impressions taken by the dentist.
- Ordered supplies necessary for daily operations of the practice.
- Instructed patients about postoperative instructions prescribed by their dentist.
- Greeted patients upon arrival at the office and escorted them to an examination room.
- Provided support services such as stocking rooms with supplies, cleaning trays and changing linens between patients.
- Reviewed patient charts prior to visits to ensure that all relevant information was available for the doctor's review.
- Assisted in laboratory procedures such as mixing impression materials or pouring casts from impressions taken by dentists.
- Handled billing inquiries from insurance companies regarding claims submitted by the office.
- Responded promptly to requests from other staff members or dentists while maintaining a professional demeanor.
Education
Associate of Applied Science Degree - Cloud Computing
El Centro
Dallas 01.2024 - Current
No Degree - Technical Support Fundamentals
Google IT Support Professional Certificate
09.2024 - Current
No Degree - Google AI Essentials
Google
09.2024 - Current
Skills
- Cloud Infrastructure Management: Skilled in cloud architecture, deployment, and infrastructure as a service (IaaS) Proficient in managing cloud environments, including AWS, Microsoft Azure, and Google Cloud
- Technical & Software Proficiency: Proficient in cloud platforms, Salesforce CRM, database management, electronic charting, and data analysis Skilled in integrating and optimizing cloud-based solutions to improve operational efficiency
- Patient Care & Clinical Support: Strong patient care, clinical support, patient counseling, patient services, patient education, chair-side support, oral healthcare, dental hygiene, procedure support, first aid training
- Medical & Dental Terminology: Proficiency in medical and dental terminology, medical coding, instrument preparation, OSHA regulations knowledge, patient care coordination, infection control procedures
- Technical & Software Proficiency: Dentrix, Open Dental, EClinicalWorks, Next Gen Healthcare, Salesforce CRM, electronic charting, insurance billing, X-ray processing, dental radiography, patient schedule management
- Administrative & Analytical Skills: Appointment scheduling, claims processing, policy investigations, insurance verification, medical records management, database management, data collection, work prioritization, analytical thinking, problem-solving, data analysis, quality control, inventory management
- Teamwork & Communication: Excellent communication, teamwork skills, customer education, team collaboration, strong writing and verbal skills, positive attitude, highly motivated, quick learner
- Healthcare Compliance & Safety: Sterilization techniques, equipment sterilization, disinfecting rooms and equipment, treatment room setup/breakdown, exam room setups, OSHA compliance
Languages
- English
- Spanish
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
Certification
- Adult First Aid/CPR/AED
References
References available upon request.
Timeline
No Degree - Technical Support Fundamentals
Google IT Support Professional Certificate
09.2024 - Current
No Degree - Google AI Essentials
Google
09.2024 - Current
Associate of Applied Science Degree - Cloud Computing
El Centro
01.2024 - Current
Claims Adjuster
WebTPA
05.2020 - 01.2024
Medical Representative
IKS Health
01.2018 - 05.2020
Dental Assistant
Dart Dental
11.2016 - 01.2018
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