Tiffany Gutierrez
Las Vegas,NV
Summary
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 5+ years of insurance experience. Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards.
Overview
15
15
years of professional experience
Work History
Claims Rep II
Elevance Health/Carelon
07.2022 - Current
- Responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures according to CMS guidelines and regulations
- Participate in claims workflow projects
- Adjusts voids and reopens claims in line within guidelines to ensure proper adjudication
- Researching and reviewing provider charges are accurate and detecting for any possible over charger or over payments made to providers
- Experience in appeals and grievances; assisting with provider disputes and accurately researching and making sure claims are processed correctly.
- Review and researches provider requests to payment reconsideration.
Patient Service Representative
Intermountain Healthcare (Durango Pediatrics)
08.2020 - 06.2022
- Checking in/out patients, answering phones and scheduling appointments
- Insurance verification
- Ensuring all patient demographics and clinical summaries are up to date in the patient charts
- Taking payments and handling daily deposits for the clinic
- Working with eligibility department to ensure patient benefits.
Billing & Collections Specialist
Durango Orthopedics Associates
08.2011 - 07.2012
- Submitting billing invoices to workers compensation insurances
- Handle prior authorizations with workers compensation for approvals
- Maintaining communication with workman’s compensation groups to assure payment collections to the clinic
- Maintaining patient accounts.
Claims Examiner I
Anthem Blue Cross
11.2009 - 07.2010
- Processing and adjusting medical claims
- Verifying insurance benefits and coverage
- Ensuring legal compliance and following all HIPAA regulations
- Resolving medical claims issues and documenting actions.
Education
High School Diploma -
Northridge Academy High School
Skills
- Conflict Resolution
- Settlement Negotiation
- Team Collaboration
- Insurance Claims Review
State
NV
Zip
89166
City
Las Vegas
Additional Information
Experience in Grievance and Appeals, resolving provider payment issues, and also bilingual in English/Spanish
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Claims Rep II
Elevance Health/Carelon
07.2022 - Current
Patient Service Representative
Intermountain Healthcare (Durango Pediatrics)
08.2020 - 06.2022
Billing & Collections Specialist
Durango Orthopedics Associates
08.2011 - 07.2012
Claims Examiner I
Anthem Blue Cross
11.2009 - 07.2010
High School Diploma -
Northridge Academy High School
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