Hi, I’m
Sherry J. Martinez
Houston,TX
Summary
A committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
13
years of professional experience
4
years of post-secondary education
Work History
Elevance Health
UTILIZATION MANAGEMENT INTAKE III
06.2017 - 05.2025
Job overview
- Determines contract and benefit eligibility, provides authorization for INPT, OUT/PT, pre-cert request
- Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care
- Act as liaison between Medical management and internal departments
- Utilizing superior communication and computer skills
- Adjudicated Medical Claims processing, investigation reimbursement integrity
- Knowledge of EOBs, CPT, ICD10, HCPCS, UB04s, and CMS 1500s
- Monitors inventory to ensure workflow remains uninterrupted
- Reviews, interprets, and maintains records of service level, quality, accuracy, and productivity
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
Anthem
PROVIDER SERVICE ANALYST
05.2014 - 06.2017
Job overview
- Maintained compliance with all Federal/State regulations internal and external policies
- Adjudication of Medical Claims
- Evaluate claims to determine claims eligible for Arbitration including state insurance department
- Instructed provider on details of reimbursement policies, community, and state products
- Scrutinize audits of claim files to ensure adherence to departmental standards
- Proven success in negotiation and technical writing
- Complete special projects and other duties per assignment
Amerigroup (Subsidiary of Anthem)
CUSTOMER CARE ADMINISTRATOR I
11.2012 - 06.2014
Job overview
- Researched complex billing errors that required in-depth review
- Initiate authorizations for providers and hospitals through calls or fax
- Process Medicaid/Medicare claims for providers and hospitals
- Demonstrated professionalism in all dealings, in resolving grievances and appeals
- Managed customer inquiries and resolved issues using CRM systems to enhance service quality.
- Coordinated communication between departments to streamline processes and improve response times.
- Consistently met or exceeded performance metrics while maintaining excellent quality scores in all areas of evaluation.
- Handled complaints, provided appropriate solutions, and alternatives within appropriate timeframes and followed up to achieve resolution.
Education
Monroe Academy For Business Law
H.S Diploma from Business & Law
09.2001 - 08.2005
The College of Health Care ProfessionsTX
Certification from Medical Billing And Coding
07.2025 - Current
Skills
- Proficient in Microsoft Excel, PowerPoint, and Microsoft Word, EPIC, QNXT, Compass, Facets, PaysSpan, I-health, Medicaid State Portals, Windows, ACS Pricing, Outlook
- Proficient Bilingual: English/Spanish communication skills, written, and verbal
- Policy Interpretation, investigation, and research skills
- Claims Processing
- Superior communicator
- Has over 7 years of Insurance Industry Experience
- Excellent reading and writing ability, good listening and speaking ability
- Knowledgeable in Medical Terminology
- Records Review - Data Verification
- Strong Organizational, analytical, and problem-solving skills
- Reliable and driven, with strong time management and prioritization abilities
- Medical Billing/Collections Experience
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
The College of Health Care Professions
Certification from Medical Billing And Coding
07.2025 - Current
UTILIZATION MANAGEMENT INTAKE III
Elevance Health
06.2017 - 05.2025
PROVIDER SERVICE ANALYST
Anthem
05.2014 - 06.2017
CUSTOMER CARE ADMINISTRATOR I
Amerigroup (Subsidiary of Anthem)
11.2012 - 06.2014
Monroe Academy For Business Law
H.S Diploma from Business & Law
09.2001 - 08.2005