Maria Vasquez
Canoga Park,CA
Summary
I am a dedicated, and organized individual. I have good interpersonal skills, I’m an excellent team worker and very willing to learn and develop new skills. I am reliable and dependable.
Overview
20
20
years of professional experience
Work History
Provider Dispute Resolutions Coordinator
Medpoint Management
05.2018 - Current
- Entered data, generated reports, and produced tracking documents.
- Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
- Managed provider disputes for successful completion, ensuring milestones were met and deadlines were adhered to.
- Enhanced customer satisfaction by responding promptly to Appeal inquiries and addressing concerns professionally.
Claims Adjuster
Conifer Health Solutions
09.2016 - 05.2018
- Adjudicate claims based on variable contract provisions and benefits according to state guidelines and ensure appeals and PDRs are accurate and processed in a timely manner
Compliance Auditor
Regal Medical Group
08.2014 - 09.2016
- Prioritize, track, and develop action plans to ensure timely completion of audits, compliance reporting and special projects
- Assist in health plan and regulatory audits and represent claims in all audit processing and regulatory compliance is maintained.
Claims Examiner
Dell
09.2013 - 08.2014
- Review and process New Jersey HMO, PPO Medicare and Medicaid , claims for United Healthcare using the Facets system
- Research claims for appropriate documentation
- Analyze and adjust data and benefit criteria for payment.
Medical Claims Examiner and Customer Service Representative
Personal Insurance Administrators
05.2008 - 08.2013
- Evaluate claims for completeness and validity to determine payment / denial according to Plan, Medical Policy and Department guidelines
- Recognize and input data from submitted claim forms using appropriate CPT and Revenue codes.
Quality Control Processor
The Mortgage Store
03.2005 - 07.2007
- Process all incoming applications for property mortgages and refinancing; verify validity of social security numbers, obtain credit reports and review applications for accuracy, verify employment status of applicant; obtain all required documentation for lending institution inquiries
Education
Associate Degree In Nursing - Nursing
Pierce College
Woodland Hills, CASkills
- Proficient in various accounting procedures; ability to work well with numbers; to concentrate on details; knowledge of various claims processing systems and procedures; EZ Cap Facets, Diamond, as well as other computerized bookkeeping procedures; spreadsheet management
- Proficient in Microsoft word and Excel; Experience using windows based claims processing applications
- Complete understanding of HCFA 1500 & UB 04 claim forms; Knowledge of CPT, ICD-9, & HCPCS coding as well as modifiers
- Experience with Professional, Institutional, and Facility claims
- Excellent written, oral, and interpersonal skills, with the ability to respond to all levels of management; ability to perform well in a high productivity environment, and tolerate pressures related to tight deadlines, and frequent interruptions
- Knowledge of Medi-Cal, and CMS guidelines
- Bilingual; English/Spanish: Ability to speak, read and translate the Spanish language
Phone
(818) 932-0041, (323) 304-9683
Timeline
Provider Dispute Resolutions Coordinator
Medpoint Management
05.2018 - Current
Claims Adjuster
Conifer Health Solutions
09.2016 - 05.2018
Compliance Auditor
Regal Medical Group
08.2014 - 09.2016
Claims Examiner
Dell
09.2013 - 08.2014
Medical Claims Examiner and Customer Service Representative
Personal Insurance Administrators
05.2008 - 08.2013
Quality Control Processor
The Mortgage Store
03.2005 - 07.2007
Associate Degree In Nursing - Nursing
Pierce College
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