Robert Guzman
Tucson,AZ
Summary
Claims Examiner with over two decades of experience in health information management, specializing in patient eligibility verification and claims processing. Demonstrates exceptional proficiency in coordinating claim adjustments and resolving pended and denied claims, ensuring organizational efficiency. Skilled in customer service, time management, data analysis, and problem-solving, ready to contribute to continued success in healthcare administration.
Overview
21
21
years of professional experience
Work History
Claims Examiner
Health Information Management Systems
2014.08 - Current
- Ensured patient eligibility verification via insurance portals
- Maintained accuracy in claims review and submission
- Efficiently coordinated claim adjustments with clients
- Exhibited problem-solving skills in resolving pended and denied claims
- Contributed to organizational efficiency by managing claims within expected timeframes
- Scheduled patients appointments with medical as well as psychiatric providers.
- Maintained up to date files on community resources and entitlements.
Enrollment Specialist
COPE Community Services Inc
2003.01 - 2014.07
- Managed patient eligibility verification for mental health services
- Coordinated intake appointments for new and returning patients
- Updated and maintained insurance data for accurate claims submission
- Oversaw the uploading of patient roster to state Medicaid
- Ensured timely downloading and integration of response files into company database
- Communicated effectively via telephone, email, and in person with prospective customers.
Education
Diploma -
Immaculate Heart High School
Tucson, AZ05.1996
Skills
Customer service
Time management
Data analysis
Problem-solving
Verbal Communication
Data Verification
Computer Skills
Customer service and support
Payment Processing
MS Office
Insurance policy coverage knowledge
Personal Information
Title: Claims Examiner
References
- Alexander Bennion, Health Information Management Systems, abennion@hmsfirst.com, 480-369-1921
- Patricia Durazo, University of Arizona, pdurazo@arizona.edu, 520-808-8800
- Heather Frank, COPE Community Services Inc, hfrank@copecommunityservices.org, 520-991-0662
Timeline
Claims Examiner
Health Information Management Systems
2014.08 - Current
Enrollment Specialist
COPE Community Services Inc
2003.01 - 2014.07
Diploma -
Immaculate Heart High School
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