Stephanie Canela
Passaic,NJ
Summary
Detail-oriented and experienced Claims Processing Representative with over one year of experience in medical claims processing, medical billing, and CSC claims processing. Proficient in Microsoft Office, including Word and Excel. Skilled in determining the appropriate action for claims following organizational policies and procedures. Seeking to leverage expertise to make a significant impact as part of the team.
Overview
2
2
years of professional experience
Work History
Medical Billing Specialist
Navient
Remote
03.2024 - 08.2024
- Managed medical billing and claims processing for a high-volume healthcare provider.
- Ensured accurate and timely submission of claims, adhering to payer-specific requirements.
- Conducted follow-up on unpaid claims and resolved denials through effective communication and appeals processes.
- Utilized Microsoft Office applications to maintain billing records and generate reports.
- Collaborated with healthcare providers and insurance companies to address billing inquiries and discrepancies.
Claims Processing Representative
Navient
Remote
02.2023 - 12.2023
- Review and adjudicate complex or specialty claims, ensuring compliance with organizational policies and procedures.
- Determine the appropriate action for claims, including return, denial, or payment.
- Utilize Microsoft Office tools, including Word and Excel, to document and manage claims processing activities.
- Maintain detailed records of claims processing decisions and actions taken.
- Provide support for quality assurance initiatives and adhere to quality standards.
- Participate in training sessions and stay updated on industry best practices and organizational policies.
Billing Representative
Sitel
Remote
12.2022 - 03.2023
- Maintained productivity and quality standards in a call center environment Successfully identified and resolved root causes of billing issues
- Investigated and rectified billing discrepancies, including incorrect charges, overpayments, and underpayments
- Operated within a remote setting as a Billing Resolution Specialist
- Eagerly engaged in complex billing queries, enhancing customer satisfaction.
Education
High School Diploma -
Name of High School
Passaic, NJ06.2018
Skills
- Medical Claims Processing: Proficient in reviewing and adjudicating complex or specialty claims
- Decision Making: Skilled in determining whether to return, deny, or pay claims based on policies and procedures
- Attention to Detail: Excellent ability to maintain accuracy and consistency in claims processing
- Technical Proficiency: Competent in using Microsoft Word and Excel; experience with Microsoft Outlook
- Time Management: Flexible start times with the ability to support business needs, including overtime
- Communication: Strong written and verbal communication skills
- Customer Service: Dedicated to providing high-quality service and support
- Available to work flexible hours with start times between 8:00 am and 6:00 pm EST, Monday to Friday, with the ability to support overtime as needed
- Strong understanding of quality assurance and compliance in claims processing
- Experience with HireVue interviewing technology
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Medical Billing Specialist
Navient
03.2024 - 08.2024
Claims Processing Representative
Navient
02.2023 - 12.2023
Billing Representative
Sitel
12.2022 - 03.2023
High School Diploma -
Name of High School