Liliana Montes
Panorama City,CA
Summary
Billing Specialist Representative and Administrative Assistant with a proven track record at Regal Medical Group, enhancing claims processing efficiency and safeguarding client data, demonstrating HIPAA compliance and exceptional follow-up skills. Achieved significant improvements in provider relations and data accuracy, leveraging both technical expertise and meticulous attention to detail.
Overview
8
8
years of professional experience
Work History
Provider Relations Representative
Regal Medical Group
2018.12 - 2024.09
- Assist providers in resolving claims issues.
- Assist and educate providers on their contract rates, Usual and Customary, and Capitation payment.
- Assist providers in Timely Filing for Appeals.
- Assist providers in the payment difference between Medicare, Medi-Cal, and Commercial line of business.
- Research and resolve routine or complex claim issues.
- Assist providers with eligibility, referral status, provider availability, case management, utilization management, prior authorizations, claims related issues and general information.
- Maintain accurate and good grammatical communication, both verbal and written, with all levels of management, staff members, and providers.
- Follow HIPPA guidelines with all information pertaining to member medical information and privacy.
- Maintained and exceeded quality and productivity standards of 65 calls or more with clear and concise detailed documentation of 90% incidents.
Administrative Assistant
Dynamic Home Health Care
2017.02 - 2018.06
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Ensured accurate record-keeping with diligent data entry and database management for vital company information.
- Assisting with coordinating and stocking medical supplies for home health patients.
Administrative Assistant
Nordayan Law Office/ Externship Site
2016.08 - 2016.09
- Supported multiple attorneys simultaneously by efficiently prioritizing tasks according to urgency or deadline requirements.
- Managed general clerical needs such as opening and closing files, scanning sheets and faxing documents.
- Facilitated clear communication between clients and attorneys by acting as a liaison to ensure all parties were informed of updates or changes.
- Prepared drafts of forms, letters and agreements for legal staff use.
- Safeguarded confidential information with strict adherence to privacy policies and professional discretion.
Education
High School Diploma -
Park Ridge High School
Long Beach, CA09.2015
UEI
Encino, CA06.2016
Skills
- HIPAA Compliance
- Claims Processing
- Follow-up skills
- Accuracy and Precision
- Customer Service
- Healthcare Industry Knowledge
Computer Applications
PC and Mac Operating Systems, Microsoft Office, Word, Excel, and PowerPoint, EZ-CAP, 65 wpm
Timeline
Provider Relations Representative
Regal Medical Group
2018.12 - 2024.09
Administrative Assistant
Dynamic Home Health Care
2017.02 - 2018.06
Administrative Assistant
Nordayan Law Office/ Externship Site
2016.08 - 2016.09
High School Diploma -
Park Ridge High School
UEI
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