Michelle Martinez

• Scanned medical records and assigned a correct chart and notified doctor if new info came in.
• Responsible for scanning 200 to 250 medical document records daily
• Sent medical records out through mail and fax when requested
• Bill for medical records for insurance companies and lawyers.
• Met customer call guidelines for service levels, handle time and productivity.
• Handled customer inquiries and suggestions courteously and professionally.

Adjusted claims and paid claims 75-100 daily after reviewing contract and insurance plans.

• Processed UB04 claims submitted with 100 plus lines and multi month overlapping days.
• Received and processed claims that were submitted thru providers in dedicated system.
• Provided additional info on claims submittal and adjusted claims as needed.
• Answered questions from peers and reviewed claims with underwriters and clients.
• Reviewed charts and flagged incomplete or inaccurate information
• Uploaded physician progress notes, history, and physicals into electronic medical records
• Analyzed complex medical records to identify discrepancies in accuracy and completeness

• Answered phones and checked in each patient at the frontdesk
• Organized all medical records for the facility and sent them out when requested
• Made appointments with drug reps and kept a calendar of visits for 2 clinics.
• Educated customers about billing, payment processing and support policies and procedures.
• Met customer call guidelines for service levels, handle time and productivity.
• Developed and updated databases to handle customer data.
• Handled customer inquiries and suggestions courteously and professionally.

• Operated front desk and set up covid vaccine clinics for Native American community.
• Verified native tribal members only scheduling and requesting funds from tribes to cover costs.

• Verified and updated credential for all employees (6,000) and adding them in multi-database
• Wrote a job description for each role within the facility
• Verified and adjusted pay rates to market standards within the Compensation department
• Verified and completing termations with accurate documentation.

• Applied for Grants for patients, Posting Payments in NextGen, Refunding Payments, Accounts receivable from 2012
• Taking payments for CareCredit Helping resolve denials from all insurance companies
• Submitting claims UB04 and 1500 claim forms
• Answered 25-30 calls a day and talked with patients daily 4-5 in person balances daily cash.

• Submitted Claims using the UB04 and 1500 forms
• Verified payments from patients and insurance companies and adjusting to correct contract rates
• Paid the difference listed or requested the overpayment back from the facility.

• Submitted Claims using the 1500 and UB04 forms to Medicare, Medicaid and all Commercial Insurance Companies
• Ensure accounts are paid according to contract guidelines and individual agreements
• Kept accurate documentation of billing records for the facility.
• Created and maintained up-to-date patient medical records to enable tracking history and preserve consistent information.
• Educated customers about billing, payment processing and support policies and procedures.
• Met customer call guidelines for service levels, handle time and productivity.

• Processed claims for five states CO/NV/CA/ VA/GA adjusting claims using the UB04 claims and 1500 claim forms plus process front end claims – this includes regular insurance plans and new Affordable Care Act plans, and adjusting as needed
• Helped new employees on the front end process and adjusting claims
• Participated in every push to reduce inventory, appeals, and general core
• Worked with all departments handling adjustments, resubmits and communications between providers and subscribers
• Kept accounts matrix to show interest paid for prompt pay and develop tracking and changes to reduce interest payments from a high of 120,000 monthly to 30,000
• Met and exceeded AHT (Actual Handle Time), and QA (Quality Assurance) goals
• Work GA inventory to help adjust and or process claims to meet GA goals high of 200,000
• Too low of 30,000
• Also, help VA meet ACA goals of 400,000
• To 50,000.

• For National accounts, responsible for taking inbound calls, and resolving customers’ needs in fast paced, high volume call centers, while providing excellent customer service, and work quality
• Additional responsibilities include answering escalated issues, researching and maintaining spreadsheets for system issues
• Participated in every push to reduce inventory, to include personal core and general core, experienced with working Blue Square, adjustments, resubmits and interplan communications
• Meet and exceed AHT (Actual Handle Time), ACW (After Call Work) and ASA (Average Speed of Answer) and QA (Quality Assurance) goals.

• Worked in correspondence from unit, for providers – this also included claim resubmits, inventory review, adjusting claims, and also communicate problems via email to other BC/BS plans, phone calls and letters to providers Meet and exceeded AHT (Actual Handle Time), ACW (After Call Work) and ASA (Average Speed of Answer) and QA (Quality Assurance) goals
• Meet hourly total of 23 inquiries per hour Also met or exceeded QA goals

Work in Call Center and answers calls for 4 states.

Managed on average 100-150 calls daily.

Met and exceeded job requirements.

Train new Call center reps.