Summary
Overview
Work History
Education
Skills
Timeline
Generic

Martha Cardenas Morales

Albuquerque,NM

Summary

Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 22 years of insurance experience. Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards. Hardworking customer service professional knowledgeable about insurance claims processes. Proven history of best-in-class service and understanding of all protocols. Dedicated to integrity and customer service work.

Overview

22
22
years of professional experience

Work History

MSRII Claims Representative

Molina Healthcare
08.2016 - 09.2018
  • Responds to calls on contact center facility by assisting providers on their claim status, and appeals status by reviewing their claim/appeals status with providers
  • Identifies and responds to provider’s needs by educating them as to why need to do to process their claims to get them paid as weather to send corrected claims, or to file their appeal on denied claim.
  • Makes attempts to resolve issues by assisting them to process their claims on a call tracking method, if claims were denied incorrectly either by wrong COB, no enrollment, or incorrect contract issues
  • Escalates calls to supervisor when necessary and appropriate
  • Responds to requests for assistance while on phone to provide fax numbers to file their appeals or corrected claims for seven States, including CA, UT, ID, NM, IL, OH, and NY
  • Edit

Health Advisor Member and Provider

Alorica Call Center for United Healthcare
Albuquerque, NM
09.2015 - 07.2016
  • 100 calls from member, and providers to assist with customer services on their medical benefits
  • Identified and responded to customer needs based on designated procedure for members/clients on their medical needs by assisting them with in network providers that will assist them with their medical needs in different specialties and fields
  • Escalated calls to supervisor when necessary, and appropriate
  • Made attempts to resolve customer issues and deescalates problems of irate members/providers
  • Provided support, and assistance as needed

Recruiter

Staff Line
Memphis, TN
08.2013 - 07.2015
  • Evaluated strengths and weaknesses of candidates through effective screening processes.
  • Recruited new employees, process criminal background checks, administered drug test by using saliva drug tests
  • E-verified each employee to verify work eligibility for employment purposes
  • Set up employee taxes, and place qualified applicants with specialized assignments
  • Filed incident reports, complaints, and accidents for employees
  • Answered multiple line telephones to assist employees with their work assignments for several of our warehouses
  • Provided employees with orientations, for several of our companies for safety and security.
  • Facilitated new employee orientations to foster positive team attitude.
  • Maintained filing system of current, prospective and future positions.
  • Pre-screened resumes prior to sending to corporate hiring managers for consideration.

Medical Charge Entry Biller

Premier Healthcare Management
09.2002 - 03.2013
  • Medical charge entry and receipt entry on patient’s copays and outstanding balances
  • Provided quickly and effectively solve patient service challenges
  • Maintain quality control/satisfaction records, and constantly seeking new ways to improve patient service
  • Answered phones and helped patient with their Medical billing questions, and helped them arranged payment plans
  • Medical insurance verification, data compilation, cost calculation, and record maintenance.
  • Examined and checked over finished parts to assess compliance to specifications.
  • Reviewed scenes to assess and identify issues and check for proper equipment usage in sandblasting tasks.

Medical Biller

Edit, NM Cardiac Care
06.2002 - 09.2005
  • Worked with cardiac specialist medical reception to off-site clinic
  • Provided prior authorization insurance verification, data compilation, cost calculation, record maintenance
  • Processed account billing and collections of patients
  • Worked directly with hospitals, labs, and other doctor’s office for the purpose of scheduling patient’s out-patient procedures, and surgeries on cardiac basis
  • Medical Billing of charge entry for all of the office visit, and procedures done at the office.
  • Reviewed patient records, identified medical codes and created invoices for billing purposes.
  • Prepared billing statements for patients and verified correct diagnostic coding.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.

Medical Biller / Medical Office Receptionist

New Mexico Cardiac Care
Las Cruces, NM
01.2002 - 01.2005
  • Worked with cardiac specialist medical reception to off-site clinic
  • Provided prior authorization insurance verification, data compilation, cost calculation, record maintenance
  • Processed account billing and collections of patients
  • Worked directly with hospitals, labs, and other doctor’s office for the purpose of scheduling patient’s out-patient procedures, and surgeries

Education

MBA -

New Mexico State University - Dona Ana Community College
Las Cruces, NM

High School Diploma -

Valley H School
Santa Ana, CA
05.1985

Skills

  • Eligibility Determinations
  • Time Management
  • Policy Modifications and Updates
  • Team Collaboration

Timeline

MSRII Claims Representative

Molina Healthcare
08.2016 - 09.2018

Health Advisor Member and Provider

Alorica Call Center for United Healthcare
09.2015 - 07.2016

Recruiter

Staff Line
08.2013 - 07.2015

Medical Charge Entry Biller

Premier Healthcare Management
09.2002 - 03.2013

Medical Biller

Edit, NM Cardiac Care
06.2002 - 09.2005

Medical Biller / Medical Office Receptionist

New Mexico Cardiac Care
01.2002 - 01.2005

MBA -

New Mexico State University - Dona Ana Community College

High School Diploma -

Valley H School

Similar Profiles

CREATE PROFILE
Martha Cardenas Morales