Traycee Garcia
Arvada,CO
Summary
I have extensive knowledge in the Healthcare Industry from large corporations to start up companies. My work experience includes all claims tasks from processing, examining and auditing claims both professional and institutional. Team Lead, Senior Claims Examiner and Recovery Specialist, Claims Supervisor for a team of 8 and most recently Appeals and Subrogation. I am a highly motivated self-starter who can adapt quickly to change and increasing responsibility. I enjoy being a individual contributor as well as being on a team of dedicated individuals.
Overview
13
13
years of professional experience
Work History
Claims Processor II
InnovAge
03.2023 - Current
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Performs core claims, appeals and correspondence processing.
- Research Subrogation claims, track and forward appropriate claims to the Legal Department for lien reimbursement.
- Resolves mid-level claims issues through contact with participants, physicians, facilities and others for claims resolutions
- Receive inbound customer service calls and answers basic claim questions in regards to claim status, verification of eligibility/benefits and escalates more involved calls to the appropriate level of customer service.
Claims Supervisor
Buffalo
06.2021 - 10.2022
- Managed team members effectively to meet high production standards with accurate results
- Collaborated with quality team regarding quality assurance reviews
- Review daily, weekly and monthly inventory and productivity reports
- Oversee day to day operations and day to day supervision of staff
- Coach and council staff as appropriate
- Recruit, interview, and evaluate applicants to assure hiring the most qualified person in accordance with HR guidelines.
Senior Claims Recovery Specialist
Apostrophe Health
06.2016 - 06.2021
- Audit and process special projects from external and internal sources
- Audit and process adjustments and provider appeals in accordance with Fee Schedules and rates specified within the provider's contract
- Communicates with clients on Claims Status Request, Primary Group Outreach (PGO) Requests and Overturn Notices
- Monitor trends and issues observed and provides feedback to Manager for opportunities for process improvement
- System testing and validation
- Audit code and process member reimbursement claims and validate EOB sent to the member for accurate payment information.
Senior Medicare Claims Examiner
Physician Health Partners
05.2011 - 05.2016
- Manage workflow to maintain turn around time requirements for daily inventory
- Assist Supervisor with monitoring daily reports for the claims department, including operations inventory to maintain compliance turnaround times.Analyze and release claims from targeted provider pended claims reports and auditing claims for correct payments prior to release of claims.
Education
Bachelor of Science - Business Management
Metropolitan State College of Denver
05.2008
Skills
- Claims Evaluation
- Verbal and Written Communication
- Team Collaboration
- File and Record Management
- Claims Processing
- Claim Audits
- Complex Problem Solving
- Claims Processing Software
Timeline
Claims Processor II
InnovAge
03.2023 - Current
Claims Supervisor
Buffalo
06.2021 - 10.2022
Senior Claims Recovery Specialist
Apostrophe Health
06.2016 - 06.2021
Senior Medicare Claims Examiner
Physician Health Partners
05.2011 - 05.2016
Bachelor of Science - Business Management
Metropolitan State College of Denver
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