Sandra Martinez-Andrade

• Collated financial details for Medi-Cal reimbursement.
• Correct Medi-Cal denial errors after conducting thorough research on cause of rejections.
• Authenticate client Medi-Cal status via state database.
• Ensured compliance with State Medi-Cal guidelines prior to resubmission.
• Facilitated Medi-cal refunds through efficient processing of deletions and voids
• Performed audits on intricate patient accounts for various contracts and County accounts.
• Handled service correction, replacement, and deletions for charge data correction invoices (CDCI).
• Delivered training sessions to Contract providers regarding Medi-Cal claims and denials. As well as our internal team.
• Produce detailed user guides tailored for team usage and contractor needs.
• Ensured client satisfaction by addressing concerns through various communication channels.
• Managed helpdesk operations efficiently to ensure smooth workflow.
• Resolved customer concerns related to claims via ticket system.
• Processed payments and denials for insurance entities and Medicare.
• Transferred denied payments efficiently to designated guarantors.
• Reviewed financial documents ensuring precision and accuracy.
• Directed and organized billers, allocating responsibilities to temporary support.
• Supported implementation of Department of Behavioral Health's new EHR system.
• Processed billing record requests submitted by legal firms and document retrieval services.

• Supervised staff workload and assignments.

• Approved absence requests and e-Time for staff.

Optimized and allocated workload tasks among team members daily.

• In collaboration with the team, established work sequence, priorities, deadlines, and work standards.

• Identified training needs to ensure staff have all the resources needed.

• Prepared training materials and procedural guides and facilitated training.

• Reviewed work product for accuracy and in accordance with billing/claiming regulations.

• Supervised the preparation and processing of spreadsheets, claims, payments, and service corrections.

• Processed and handled insurance, Medicare, and private pay claims for services provided.
• Evaluated eligibility for potential benefits under various insurance plans including Medical, Medicare, and private insurance.
• Handled remittance advice for insurance and Medicare denials and payments.
• Handled front desk operations including payment collection and documentation.
• Inspected ledger records for accuracy.
• Delivered exceptional customer service to clients.
• Oversaw training of WEX personnel for various clerical functions.

• Provided exceptional customer service at the reception area.
• Conducted patient interviews to assess program eligibility for financial assistance.
• Verified Medi-Cal and MIA eligibility using computer systems.
• Researched patient account details to ensure correctness.
• Managed legal document compliance for subpoenas.
• Audited patient accounts, received payments and calculated applicable account discounts.

Processed items using pharmacy electronic billing system.

Conduct revisions of pharmacy account records.

Validated coverage details with insurers.

•Bill specialized State breast programs for pharmacy services.

Conducted copy checks for bank deposits.

Oversaw handling of bank deposits.

Processed accounts, checks and statements using 10-key.

Interpret conversations to assist Spanish speakers.

• Managed client intake at reception desk effectively.
• Managed receipt and organization of subpoenas.
• Managed appointment-related documentation.
• Organized documents and managed light telephone correspondence.
• Supported clients in interpreting received correspondence.
• Facilitate interview translations.
• Organized and handled mailroom duties efficiently.

• Managed customer phone inquiries.
• Processed checks and various other financial items using a 10-key.
• Created organized records for new clients
• Organized documents into client-specific directories.
• Determine financial records for clients and child support officers.
• Generated ledgers for clients to discuss accounts

Managed file room operations.