Valerie Jimenez
Fairfield,CA
Summary
Experienced Medical Claims Specialist successful at maintaining high volume of claims in fast-paced environment. Organized, driven and adaptable with problem-solving abilities. Offering over 15 years of professional experience and willingness to take on any challenge.
Overview
14
14
years of professional experience
Work History
Claims Specialist
Partnership HealthPlan Of California
Fairfield, CA
05.2019 - 02.2022
- Apply appropriate course of action to process claim adjustment requests.
- Participate in special claim adjustment projects as assigned.
- Assist Claims examiners with processing claims as needed.
- Review all work audits and submit corrections within allotted time frame.
- Analyze family planning and emergency room reports to identify and adjust services prior to check run to prevent erroneous denials.
- Maintained confidentiality of patient finances, records and health statuses.
- Process and complete average of 150 complex claims each week.
Claims Examiner I
Partnership HealthPlan Of California
Fairfield, CA
02.2016 - 05.2019
- Researched and resolved claims for Medi-cal claim types within established production and quality standards of 300+ claims processed and completed per day.
- Completed claims per day from Child Health and Disability Prevention error reports.
- Routed claims to appropriate Partnership Healthplan departments and internal staff for additional review.
- Generated claims correspondence as needed.
- Review all work audits and submit corrections within allotted time frame.
- Maintained confidentiality of patient finances, records and health statuses.
Child Health and Disability Prevention Screener
Partnership HealthPlan Of California
Fairfield, CA
10.2012 - 02.2016
- Conducted initial screening of Child Health and Disability Prevention claims for completeness.
- For incomplete claims, prepared rejection letters and returned documents to providers.
- Provided clerical and general office support.
- Opened, sorted and prepared claim batches and distributed incoming and outgoing mail for Claims department.
- Scanned and indexed claims documents.
- Assembled closed files for offsite storage.
- Maintained confidentiality of patient finances, records and health statuses.
Construction Loan Operations Processor I
Bank Of The West
San Ramon, CA
09.2007 - 10.2012
- Prepared loan transaction documentation including: general ledger tickets, commercial loan system tickets and loan transmittals.
- Processed loan payoffs, monthly interest and principal payments and disbursements.
- Activated new loans and closed out paid loans.
- Checked loan packages for appropriate documentation.
- Provided quick turnaround times to maintain time sensitive deadlines.
Education
High School Diploma -
Vanden High School
Fairfield, CA06.1997
Skills
- Analytical Skills
- Attention to detail
- Documentation review
- Problem solving
- Team building
- Organization and Time management
- Proficient in Microsoft Word and Outlook
- Medical claims payment processing
- Excellent communication
Timeline
Claims Specialist
Partnership HealthPlan Of California
05.2019 - 02.2022
Claims Examiner I
Partnership HealthPlan Of California
02.2016 - 05.2019
Child Health and Disability Prevention Screener
Partnership HealthPlan Of California
10.2012 - 02.2016
Construction Loan Operations Processor I
Bank Of The West
09.2007 - 10.2012
High School Diploma -
Vanden High School
Similar Profiles
Chloe UngaroChloe Ungaro
Supervisor of Utilization Management Operations at Partnership HealthPlan of CaliforniaSupervisor of Utilization Management Operations at Partnership HealthPlan of California
Sushma ReddySushma Reddy
Senior Business Analyst at Partnership HealthPlan of CaliforniaSenior Business Analyst at Partnership HealthPlan of California
William KinderWilliam Kinder
Senior Manager at Partnership HealthPlan of CaliforniaSenior Manager at Partnership HealthPlan of California