Summary
Overview
Work History
Education
Skills
Timeline
Generic
SHAY CRUZ

SHAY CRUZ

Garden City,ID

Summary

Organized team leader builds positive rapport, inspires trust and guides teams toward achievement of organizational goals. Strong facilitator with 10+ years of medical billing and medical office management experience. Excellent trainer and mentor.

Overview

12
12
years of professional experience

Work History

Claims Resolution Team Lead

WPS
Madison, WI
01.2023 - Current
  • Facilitates new hire training classes, training on basics like claims processing procedures, software applications and federal laws/regulations pertaining to the administration of Tricare and federal HIPAA guidelines
  • Manages team of 12 processors, establishing team goals and priorities, leads team meetings, monitors & evaluates performance and conveys constructive feedback to improve skills
  • Cross-trains existing employees to maximize team agility and performance.
  • Reduces operational costs through comprehensive process improvement initiatives and resource management.
  • Communicates effectively and extensively with other departments to resolve complex claims issues efficiently and effectively.
  • Prepares clear and concise reports for management review, showcasing insights into trends within department performance metrics

Claims Processor-Team Lead

Ameriben
Meridian, ID
09.2019 - 12.2022
  • Managed team of processors, established team priorities, deadlines and workloads, led staff meetings and evaluated performance
  • Facilitated training, developed policies and procedures and created training material, established a strong foundation that supported growth and success within the organization.
  • Fostered open and professional relationships with team members to achieve quick resolutions for various issues.
  • Collaborated with other department leads to streamline workflows and achieve goals collectively.

Medical Billing Manager

Dermatology Clinic Of Idaho
Boise, ID
01.2016 - 08.2019
  • Managed billing office team, ensured compliance with company policies and industry regulations by providing necessary training to employees
  • Posted and adjusted payments from insurance companies
  • Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience
  • Managed patient accounts effectively, resolving discrepancies and addressing outstanding balances in a timely manner
  • Enhanced revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.
  • Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.

Education

Bachelor of Science - Criminal Justice

Boise State University
Boise, ID
05.2011

Skills

  • Problem-Solving
  • Teamwork and Collaboration
  • Attention to Detail
  • Coaching and Mentoring
  • Staff education and training
  • Process Improvement
  • Organizational abilities
  • Conflict Resolution
  • Critical Decision-Making
  • HIPAA compliance awareness
  • Medical terms and procedure knowledge
  • Microsoft Office

Timeline

Claims Resolution Team Lead

WPS
01.2023 - Current

Claims Processor-Team Lead

Ameriben
09.2019 - 12.2022

Medical Billing Manager

Dermatology Clinic Of Idaho
01.2016 - 08.2019

Bachelor of Science - Criminal Justice

Boise State University

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SHAY CRUZ