PAULA SAENZ
El Paso
Summary
Organized and dedicated Administrative Assistant with proven track record of providing exceptional customer service in fast-paced environments. Offering keen attention to detail and strong decision-making skills to manage multiple, concurrent tasks. Self-motivated work ethic to perform effectively in independent or team environments.
Overview
7
7
years of professional experience
Work History
Operations Admin Specialist
Charles Schwab
08.2023 - Current
- Reviewing client account money movement requests including but not limited to check requests, check deposits, and contribution amounts.
- Followed rules and compliance policies regarding banking regulations.
- Problem-solving and conducting research when needed
- Boosted client satisfaction with timely and accurate responses to inquiries and concerns regarding financial banking matters.
Remote Claims Analyst
Bright health care Insurance
01.2022 - 03.2023
- Reviewed Medical and Behavioral health insurance claims
- For accuracy and completeness as well as eligibility
- Participated in audits coordinating with compliance and legal to ensure provided all the requested data before being sent to the Department of Insurance
- Navigated through different systems such as Genelco, OI portal, care radius, EMDI, and used Excel spreadsheets
- Created Pivot tables.
Customer Service Representative
TriWest
06.2021 - 01.2022
- Care for Veterans and providers in a fast-paced contact center
- Responded to inbound calls regarding authorizations for medical and behavioral health care, provided status and eligibility, as well as claim and payment status
- Accurately assessed
- Callers’ requests while focusing on first call resolution and/or appropriate call escalation protocols.
Medical Claims Analyst
Datamark
04.2020 - 06.2021
- Responsible for claim monitoring and administrative report generation
- Communication with claimants, providers, claims examiners, and lawyers
- Run eligibility
- Coverages and check for authorizations
- Advised of eligible ICD 10, CPT, and HCPCS codes for claimants under their treatment suites
- Stayed current with HIPAA
- Regulations, benefits claim to process, medical
- Terminology, and other procedures
- Accurately processed a large volume of medical claims every shift
- Evaluated pending claims to identify and resolve them
- Problems blocking auto adjudication
- Reviewed claims
- For accuracy before submitting for billing.
Medical Coding and Billing Specialist
University Medical Center
01.2020 - 03.2020
- Coordinate and research coding discrepancies identified for timely correction and/or confirmation of codes
- Review medical records and determine correct principal diagnoses and procedures for proper assignment of ICD 10 CM and CPT codes to document diagnoses and procedures
- Abstract medical record information into hospital database with proper assignment of disposition
- Used EMR, Sorian, and
- Cerner systems
- Reviewed and received payments for accuracy and applied to patient's accounts
- Reviewed medical records to meet insurance company requirements
- Sought clarification from providers and other hospital medical staff personnel for answers needed for coding interpretations prior to abstracting records
- Added modifiers or appropriate coded narrative diagnoses and verified diagnoses.
Billing Specialist
AARP
12.2016 - 12.2019
- Field calls from existing AARP members to assist memberships, renewals, research, technical assistance, and profile updates to ensure membership retention
- Work in a virtual environment from home
- Analyzed clients' needs and financial situations to customize insurance policies for individual necessity
- Calculated premiums and established payment methods
- Created individualized proposals for clients to include coverage options, premiums, and enrollments guidelines
- Coordinated enrollment into plan benefits directly with insurance company
- Explained coverage options to potential policyholders, answering questions or concerns.
Education
Bachelor’s - Business administration
Vista College
2022
Associates - Medical billing and coding
Vista College
2020
Skills
- Insurance claims management
- Medical Terminology
- Facets
- Claim Validity Information
- Proficient in
- Microsoft programs, cerna, sorium, 3m, excel, pivot tables, EMS
- Insurance plan verification
- Spanish speaking
- Sales banking and property and casualty insurance
Timeline
Operations Admin Specialist
Charles Schwab
08.2023 - Current
Remote Claims Analyst
Bright health care Insurance
01.2022 - 03.2023
Customer Service Representative
TriWest
06.2021 - 01.2022
Medical Claims Analyst
Datamark
04.2020 - 06.2021
Medical Coding and Billing Specialist
University Medical Center
01.2020 - 03.2020
Billing Specialist
AARP
12.2016 - 12.2019
Bachelor’s - Business administration
Vista College
Associates - Medical billing and coding
Vista College
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