Veronica Inda
Corona,CA
Summary
Detailed oriented Lead Claims Specialist at Providence Medical Foundation with a track record in claims processing and effective communication. Expert in analyzing and adjusting claims, ensuring accuracy and compliance. Renowned for exceptional problem-solving skills and attention to detail, fostering positive relationships with health plans and providers to achieve optimal outcomes.
Overview
24
24
years of professional experience
Work History
Lead Claims Specialist
Providence Medical Foundation
Anaheim, CA
11.2000 - Current
- Handle claim appeals and grievances from various health plans when a provider disagrees with how Providence Medical Foundation (PMF) processed their claims, or if a patient disagrees with the amount PMF has applied as the patient liability.
- Research the claim, review the Division of Financial Responsibility (DOFR), and verify the patients' benefits before making any adjustments and responding to the health plans.
- Document in detail the reasons a claim is adjusted or not.
- Communicate in detail the outcome of each appeal, and provide supporting documentation in each response.
- Reach out to the billing offices via phone or email to try to resolve the issue in a timely manner.
- Precisely calculate the necessary adjustments.
- Determined liability, compensability, and benefits due on each claim.
- Provided exceptional customer service to maintain positive relationships with all parties.
- Utilized claims software systems to manage and track claims progress.
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
Education
High School Diploma -
Saddleback High School
Santa Ana05-1991
Skills
- Claims processing
- Documentation skills
- Effective communication
- Problem solving
- Claims software
- Medical terminology
- Attention to detail
- Critical thinking
- Research skills
- Claims investigation
- Verbal communication
- Claims
- 10-key touch
- Communication skills
- Team building
- Insurance claim forms review
- Payment and investigation escalations
- Policy implementation
- Denied claims identification
- Documentation
- Analytical thinking
- Claims adjustment
- Teamwork skills
- Claims documentation
- Data entry
- Multitasking Abilities
Languages
English
Professional
Spanish
Professional
Affiliations
- Enjoy family time, traveling, trying new restaurants, or staying home.
Timeline
Lead Claims Specialist
Providence Medical Foundation
11.2000 - Current
High School Diploma -
Saddleback High School