Lilia Gastelum
Phoenix,AZ
Summary
Experienced professional with expertise in claims processing, healthcare compliance, and insurance verification. Skilled in communicating with medical professionals and patients, ensuring accurate and efficient handling of medical claims. Seeking to leverage knowledge and experience as a Medical Claims Processor to support and enhance the operations of a dynamic healthcare team. Reliable worker with excellent communication, time management, and computer skills. A driven and detail-oriented individual with a desire to use analytical and problem-solving skills to meet goals.
Professional caretaker with proven history of delivering high-quality care and support. Skilled in creating safe and nurturing environment, ensuring well-being of those under care. Team-oriented with strong commitment to achieving positive outcomes and adapting to changing needs. Reliable and skilled in time management and interpersonal communication.
Overview
24
24
years of professional experience
Work History
Caretaker
Private Care
Tucson, AZ
11.2015 - 02.2017
- Developed personalized care plans based on individual needs and preferences.
- Trained new staff in caregiving techniques and safety protocols.
- Coordinated activities to promote social engagement among residents.
- Managed medication schedules, ensuring compliance with health regulations.
- Implemented process improvements to enhance operational efficiency in care delivery.
Medical Claims Specialist
First Health
Tucson, AZ
05.1997 - 08.2012
- Developed and implemented strategies to ensure compliance with all applicable laws and regulations related to medical claims processing.
- Communicated effectively with internal departments including customer service representatives, sales team members, IT personnel, regarding billing issues impacting customers.
- Documented all findings from investigations into discrepancies on individual accounts or batches of accounts submitted for payment.
- Verified patient information on claims paperwork, checking for and preventing mistakes.
- Communicated with patients by answering questions, providing helpful information and distributing paperwork.
- Resolved discrepancies in claims through thorough investigation and effective communication with stakeholders.
- Processed and adjudicated medical claims to ensure accuracy and compliance with regulations.
Customer Support Specialist
Convergys
Tucson, AZ
02.1993 - 05.1997
- Efficiently identified customer needs through active listening and questioning techniques.
- Conferred with users, and conducted computer diagnostics to investigate and resolve problems and to provide technical assistance and support.
- Created detailed reports outlining the status of each technical issue reported by customers.
- Resolved customer inquiries through various communication channels, ensuring timely and accurate information delivery.
- Collaborated with cross-functional teams to improve service processes and customer support strategies.
Education
High School - Major Studies
SunnySide High School
Tucson, AZ05.1986
Skills
- Claims processing
- HIPAA
- Healthcare compliance
- Insurance Verification
- Communicating with medical Dr
- Communicating with Patients
- Housekeeping tasks
- Personal care
- Safety awareness
- Meal preparation
- Compassionate caregiving
- Personal hygiene maintenance
- Medication distribution
- Medication reminders
- Companionship skills
- Safety protocols
- Decision-making
- Problem-solving
- Microsoft office
LANGUAGES
Spanish Conversational
Timeline
Caretaker
Private Care
11.2015 - 02.2017
Medical Claims Specialist
First Health
05.1997 - 08.2012
Customer Support Specialist
Convergys
02.1993 - 05.1997
High School - Major Studies
SunnySide High School