Leslie Tellez
Long Beach,United States
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
7
7
years of professional experience
Work History
Senior Claims Examiner
Molina Healthcare
02.2020 - Current
- Maintained knowledge of benefits claims processing, claims principles, medical terminology, procedures, and HIPAA regulations.
- Managed over one hundred plus medical claims on a daily basis.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Reviewed provider coding information to report services and verify correctness with less than five percent errors
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Researched claims and incident information to deliver solutions and resolve problems within 24 hours.
- Overseeing team members to ensure that all productivity and quality standards are met.
- Helped train new employees
- Handled high-dollar itemized claims that were over two million dollars.
- Managed daily reports using Word and Excel.
- Completed multiple claims in multiple states such as Kentucky, Idaho, Texas, New York, Virginia, and Arizona.
- Investigated legal issues pertaining to Inpatient, Outpatient, and professional claims.
- Investigating claims thoroughly to ensure they meet all requirements, including legal standards and company policies.
- Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation.
- Researched tracers, adjustments, and re-submissions.
- Adjudicated or re-adjudicated claims in a timely manner to ensure compliance within department turn-around time and quality standards.
- Assisted in claims auditing using the system auditing dashboard.
- Assisting in the claims reworks project.
Logistics Coordinator
TDS Logistics
04.2017 - 02.2020
- Responded to a high volume of customer inquiries via email and phone call.
- Tracked orders and notified customers of status or potential delays.
- Generated documentation and information required for customer shipments.
- Monitored inbound and outbound freight operations to establish timely delivery of containers.
- Coordinated shipping requests for expedited delivery and documented accurately to achieve correct billing.
- Planned and supervised shipments from production to end-user and scheduled daily and weekly routes.
- Generated monthly performance reports to track and analyze shipping trends.
- Performed regular audits and assessments of logistics processes to identify weaknesses, and improve supply chain operations.
- Registered vendors and customers on database to maintain updated roster.
- Devised routing plans and schedules to facilitate safe and timely delivery of goods.
- Negotiated contracts to secure favorable rates and terms.
- Developed and implemented strategies to reduce costs and improve quality of service.
- Identified opportunities for inventory reductions.
Education
No Degree - Criminal Justice And Health
El Camino College
06.2017
Skills
- Medical Records Management
- Diagnostic Codes
- ICD-9-CM Coding
- HIPAA Regulations
- Medical Billing and Coding
- WorkFlow
- QNXT
- SalesForce
- PEGA A&G
- Claims Adjustments
- High Dollar Itemized Claims Processing
- Auditing
- Managing Daily Reports
- iServe
- Call Tracking
- Word
- Excel
- Microsoft Teams
- Data Analysis
- SQL Server Reporting Services
- SQL
- NetworX Pricer
- Workload Delegation
- Analytical Thinking
- Fleet Dispatching
- Transportation and Logistics Coordination
- Budget Preparation
- Database Maintenance
- Cost and Benefit Analysis
- Shipment Routing
- Delivery Tickets
- Systems Evaluation
- Call Center Operations
- Customer Relationship Management (CRM)
Timeline
Senior Claims Examiner
Molina Healthcare
02.2020 - Current
Logistics Coordinator
TDS Logistics
04.2017 - 02.2020
No Degree - Criminal Justice And Health
El Camino College