Rachel Craig
Long Beach,CA
Summary
Dynamic healthcare professional with over 9 years of experience specializing in claims processing, billing, and HIPAA compliance. Proven ability to resolve issues efficiently while enhancing provider satisfaction in fast-paced environments. Committed to delivering high-quality service and fostering strong relationships within the healthcare community. Adept at navigating complex regulatory frameworks to ensure compliance and streamline operations.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Associate Analyst, Provider Configuration
Molina Healthcare
Long Beach, CA
11.2023 - 07.2024
- Streamlined provider information updates, enhancing accuracy for claims and databases.
- Oversaw accuracy and compliance of contracts and credentialing data, reducing errors.
- Conducted audits of provider records, achieving compliance and identifying in potential database errors.
- Facilitated a increase in accuracy for claims processing and reporting.
Claims Examiner
Molina Healthcare
Long Beach, CA
06.2022 - 11.2023
- Resolved over 100 claims inquiries weekly to enhance satisfaction.
- Resolved 95% of escalated claims issues, enhancing adjudication efficiency by 20%.
- Trained over 50 providers on support tools, improving service delivery by 30%.
Service Fulfillment Specialist
Molina Healthcare
Long Beach, CA
02.2022 - 06.2022
- Resolved member inquiries on claims and coverage, increasing provider and customer's resolution.
- Documented issues in CRM systems with compliance focus.
- Collaborated with teams to improve service delivery.
Claims Call Center Representative
Molina Healthcare
Long Beach, CA
02.2021 - 02.2022
- Provided phone support to healthcare providers regarding claims status and resolution.
Medical Billing / Administrative Assistant / Customer Service
Avalon Health, Inc.
Long Beach, CA
05.2009 - 02.2020
- Processed medical billing, including Victims of Crime (VOC) claims.
- Maintained records, reconciled financial reports, and assessed coding accuracy.
- Managed communications with professionalism.
Education
Medical Biller Certificate -
Downey Adult School
Downey, CA08.2025
Skills
- Claims processing expertise
- Experience with Medi-Cal and commercial plan compliance
- Software: Microsoft Office Suite (Word, Excel, Outlook, PowerPoint)
- Data Management: Accurate data entry, regulatory compliance, provider configuration
- Thorough documentation skills
- Medical terminology proficiency
- Claims management systems
Accomplishments
- Documented and resolved claims and provider issues which led to satisfactory.
- Achieved good time management through effectively helping with that are deemed priority.
Certification
I currently have a certification for medical billing and coding .
Timeline
Associate Analyst, Provider Configuration
Molina Healthcare
11.2023 - 07.2024
Claims Examiner
Molina Healthcare
06.2022 - 11.2023
Service Fulfillment Specialist
Molina Healthcare
02.2022 - 06.2022
Claims Call Center Representative
Molina Healthcare
02.2021 - 02.2022
Medical Billing / Administrative Assistant / Customer Service
Avalon Health, Inc.
05.2009 - 02.2020
Medical Biller Certificate -
Downey Adult School