Patricia Sandoval
Tucson,AZ
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Claims Billing Specialist, with processing claims, data analysis, researching projects providing the root cause analysis and solution. Advanced skills in billing and coding, project management, claims adjusting and team lead. With tenured experience in healthcare industry. Enjoys creative problem solving, team building and getting exposure on multiple projects. Advanced skills in Excel and Microsoft applications, Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.
Overview
22
22
years of professional experience
Work History
PROJECT SYSTEMS & PROJECT SPECIALIST
Banner Health Plans
Tucson, AZ
11.2021 - Current
- Evaluated and interpreted service requests, issuing recommendations to assist planning, organization and expansion of large-scale projects.
- Serve as navigator between provider network and internal departments in effectively identifying, reviewing, and resolving full range of complex system issues received from providers. Resolving root cause analysis regarding provider contracts, prior-authorization, system issues, claims processing, claims submission errors, reimbursement methodologies, provider load issues, and other operational needs. Verify eligibility and benefits via Medicaid system.
- Concerns received for all product lines across all types of providers including, but not limited to primary care providers, specialty care providers and hospital facilities.
- PSPS will conduct and facilitate virtual provider monthly meetings that influence internal and external stakeholders addressing education needs relative to all product lines, utilization management, claim submission, and back-end issues resolution requirements of each assigned provider’s contract.
Claims Specialist
EASTER SEALS FOUNDATION
Tucson, AZ
05.2021 - 10.2021
- Responsible for submitting claims to multiple payers, posting payments, working denials, and following up with appeals when necessary.
- Billing and Claims Specialist will run and analyze reports pertaining to claims and accounts receivables to ensure that all charges are submitted and collected within time frames defined in contracts with funding sources.
- Responsible for providing reports on billing and claims to leadership.
- Gathers and submits initial claims to assigned payers, either electronic directly to funder, through clearing house or on paper claim forms.
- Posts payments electronically to health record system, conducts claims analysis to address patterns of underpayments and/or denials, responsible for finding solutions, working assigned claims, identifying and documenting problematic issues that prevent successful and timely submission of accurate claims, and reviews EOBs and processes rejections and denials in timely manner, as prescribed by funding contracts.
ARIZONA UNEMPLOYMENT INSURANCE ADJUDICATOR
State of Arizona Department of Economic Security
Tucson, AZ
10.2020 - 05.2021
- Responsible for providing quality customer service to public while interviewing and gathering pertinent information to complete benefit determination process and complete more in-depth investigations of more difficult or complex eligibility issues.
- Per accordance with administrative law, to process and write legal non-monetary determinations of claimants right to receive benefits and/or changeability to employer tax accounts.
- Responsibilities include examining and maintaining wide range of unemployment compensation accounts/cases/application and respond to multiple customer inquiries from variety of sources.
- Review claims for eligibility of unemployment benefits, for disputed (protested) claims and investigate complex unemployment benefits claims and eligibility issues.
- Gather rebuttal information related to disputed job separation issues and determine relevant facts to formulate conclusions on benefit eligibility.
ADMINISTRATIVE SUPPORT SPECIALIST SR.
Pima County Behavioral Health
Tucson, AZ
07.2017 - 02.2020
- Responsible for processing Court Ordered Evaluation (COE) and Court Ordered Treatment (COT) claims.
- Verify eligibility and benefits for inmates via AHCCCS system, create and management projects, review data and reports of claims processed, and payments.
- Interact with Pima County Procurement finance department to obtain payment for these services. For COT and COE services.
- Responsible for training any new hire staff on systems used to process claims and provide on job training HIMS.
CLAIM/BILLER SPECIALIST
ASSOCIATED DERMATOLOGISTS
Tucson, AZ
06.2016 - 07.2017
- Responsible for claim submission and follow up with insurances for services, calculating and collecting payments for medical procedures and services.
- Including patient front-end check out, updating patient data, developing payment plans, preparing invoices, payment posting, collect and review referrals and pre-authorizations, monitor and record late payments, follow-up on missed payments and resolve financial discrepancies.
- Examine patient bills for accuracy and request any missing information, investigate and appeal denied claims and maintain billing software by updating rate change, cash spreadsheets, and current collection reports.
- Monitored compliance with applicable laws, regulations, and policies related to insurance claims processing.
- Advised customers on their rights under various types of insurance coverage plans.
- Reviewed and verified customer information to ensure accuracy of claims.
- Identified and resolved discrepancies between estimated costs and actual payments received from carriers.
Claims Specialist
DEPENDABLE HEALTH SERVICES
Tucson, AZ
06.2016 - 02.2017
- Responsible for submitting error-free claims, processing and resubmitting all denied claims in timely fashion and required to follow up on unpaid accounts with numerous health plan,
- Create billing batches from software system, understanding claim form requirements for each Health Plan and validating each claim form type to comply with those requirements, submit bills manually or electronically, daily working of short pays, denials, unpaid AR over 60 days old for payment resolution.
- Correct claim errors reported on unbilled transaction reports and manual entry of Medicare and other Health Plan claims as required.
- Responsible for payroll for temporary employees, review time cards and create batches to send to finance department for pay checks.
Revenue Cycle Coordinator I
University of Arizona Medical Center
Tucson, AZ
08.2008 - 05.2013
- Responsible for performing general accounts receivable functions regarding revenue, billing, and cash processes, uploading or keying revenue received from operations.
- Follow billing schedule to ensure claims are billed in timely manner, work with operations to resolve denials, complete month-end close processes, such as revenue balancing and reporting,
- Lead monthly AR calls with assigned operations to work aging as well as participate in monthly Critical Account calls for entire region, follow proper procedures for revenue adjustments, work unapplied cash and complete cash transfers.
- Including daily cash deposits and cash control sheets daily, assist with reviewing and processing refund requests, charge backs, returns and bad checks, field questions throughout month regarding revenue, billing, and aging issues and communicate with customers in timely manner regarding claims, invoice payments, phone inquiries and account updates.
- Performed data entry tasks such as entering patient demographics into system.
Data Analyst
Cope Community Services
Tucson, AZ
05.2002 - 06.2008
- Analyzed large datasets to identify trends, patterns and correlations for business insights.
- Translated raw data into meaningful information using statistical techniques.
- Utilized data analysis to monitor process efficiencies and identify data integrity exceptions.
- Utilized advanced analytics tools such as SAS, SPSS, Excel PowerPivot, to manipulate large volumes of structured and unstructured data sets.
- Verify eligibility and benefits for members via the AHCCCS system, 270/271 reports.
- Create and manage projects, review data and reports of claims processed, and payments.
- Responsible for training any new hire staff on the systems used to process claims and provide on the job training HIMS.
- Data entry, office manager, claims processing and maintaining contracts loaded into system.
- Review reports 835/837.
Education
High School Diploma -
Desert View High School
Tucson, AZ05-1989
Skills
- Organizational and Multitasking skills
- Analytical
- Active listening
- Team and Project management
- Customer service
- Communication
- Critical thinking and Decision-making
- Problem resolution
- Training & development
- Microsoft Office
- Healthcare Administration
- Health Insurance billing and review
- Research and Root Cause Analysis
Timeline
PROJECT SYSTEMS & PROJECT SPECIALIST
Banner Health Plans
11.2021 - Current
Claims Specialist
EASTER SEALS FOUNDATION
05.2021 - 10.2021
ARIZONA UNEMPLOYMENT INSURANCE ADJUDICATOR
State of Arizona Department of Economic Security
10.2020 - 05.2021
ADMINISTRATIVE SUPPORT SPECIALIST SR.
Pima County Behavioral Health
07.2017 - 02.2020
CLAIM/BILLER SPECIALIST
ASSOCIATED DERMATOLOGISTS
06.2016 - 07.2017
Claims Specialist
DEPENDABLE HEALTH SERVICES
06.2016 - 02.2017
Revenue Cycle Coordinator I
University of Arizona Medical Center
08.2008 - 05.2013
Data Analyst
Cope Community Services
05.2002 - 06.2008
High School Diploma -
Desert View High School
Similar Profiles
Migdelia ArvizuMigdelia Arvizu
ALTCS Case Manager at Banner University Health PlansALTCS Case Manager at Banner University Health Plans
Michael KrusenMichael Krusen
Vice President, Provider Network Operations at Jefferson Health Plans (formerly Health Partners Plans)Vice President, Provider Network Operations at Jefferson Health Plans (formerly Health Partners Plans)
AnnMarie FanelliAnnMarie Fanelli
Customer Service Representative at Health First Health PlansCustomer Service Representative at Health First Health Plans