Michelle Parra
Albuquerque
Work Preference
Summary
Resourceful Medical Claims Adjuster known for being highly productive and efficient in task completion. Possess specialized skills in medical coding, claim investigations, and regulatory compliance which enable handling of claims with precision and accuracy. Excel in critical thinking, problem-solving, and communication, ensuring successful negotiation outcomes and customer satisfaction.
Overview
2
2
years of post-secondary education
10
10
years of professional experience
Work History
Medical claims adjuster
United Healthcare
Albuquerque
04.2017 - Current
- Reviewed and processed medical claims for accuracy, completeness, and adherence to insurance policies and guidelines
- Verified patient eligibility and coverage
- Reviewed benefits before claim submission
- Assisted in helping hands which is real time claim overview and adjustment in addition to regular assigned work.
- Volunteer in pilot programs for developing processes and projects.
- Facilitated timely resolution of outstanding claims by proactively following up with payers, enhancing claims processing efficiency
- Maintained a high level of productivity while meeting quality standards in processing a large volume of claims daily
- Detected fraudulent activities and billing errors through thorough claims data analysis, improving compliance and reducing risk
- Documented all actions taken during claims review process for audit purposes, ensuring traceability and accountability
Lead teacher
La petite
Albuquerque
05.2016 - 04.2017
- Led a team of 2 teachers in delivering high-quality instruction and maintaining a positive classroom environment
- Led team of 2 teachers to deliver high-quality instruction and foster positive classroom environment
- Utilized various teaching strategies, such as differentiated instruction and project-based learning, to enhance student engagement and comprehension
- Differentiated instruction based on each student's unique abilities, interests, or learning styles
- Collaborated with colleagues to create curriculum materials aligned with state standards and school objectives, enhancing educational consistency
- Implemented effective behavior management techniques to create a respectful and inclusive classroom culture
- Mentored new teachers by guiding instructional practices and classroom management strategies, supporting their professional growth
Education
Associate's degree - Social science
CNM
Albuquerque, NM 01.2013 - 01.2015
Skills
- Claims processing
- Risk assessment
- Data privacy protocols
- Proficient computer skills
- Organizational skills
- Adaptability
- Ongoing training
Additional Information
Resolved provider inquiries in real time to help pay their claims, or provide answers to why their claim has denied so they may correct any errors found., In the position I currently hold, the one thing that is constant is change, and this has helped in my ability to adapt.
Timeline
Medical claims adjuster
United Healthcare
04.2017 - Current
Lead teacher
La petite
05.2016 - 04.2017
Associate's degree - Social science
CNM
01.2013 - 01.2015