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
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
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
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, ID05.2011
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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