Carina Rodriguez
Rialto
Summary
To utilize my technical skills for achieving the target and developing the best performance.
Overview
2019
2019
years of professional experience
Work History
Analyst, Config Info Mgmt
Molina Healthcare
2021 - 2024
- Collaborated with cross-functional teams to streamline workflow and improve service delivery.
- Spearheaded the migration of critical customer correspondence using the TriZetto Configuration Migration Utility, ensuring 100% data integrity during the transition to final production.
- Configured and deployed comprehensive educational assessments using Content Editor, ensuring 100% alignment with curriculum standards and learning objectives.
- Transformed complex evaluation data into structured documentation, providing management with clear insights for decision-making.
- Analyzed complex assessment outcomes using Excel, transforming raw data into actionable insights for project managers.
Claims Representative
Amplus Group
01.2019 - 2021
- Driven and self-motivated, and therefore effective at completing tasks with minimal supervision.
- Being able to navigate from Microsoft Word to Microsoft Excel to obtain claim information.
- Creating worksheets in Microsoft Excel and applying filters to organize patient demographic information and claim information.
- I worked with programs such as Epic to register daily ambulance services provided to our patients.
- Meet daily productivity.
- Utilize provider portals to obtain eligibility and claim information.
- Review Electronic Remittance Advice (835) and EOB’s for appropriate adjustments and payments.
- Perform additional duties as needed to meet client and company expectations.
Claims Representative
Team Health
01.2018 - 01.2019
- As part of the Accounts Receivables team I have been able to work with claims that have not been resolved. I use provider portals and call insurances to provide the statuses for these claims. Once information has been obtained, the correspondence needs to be reassigned to the correct department
- Daily use of provider portals to gain payment information from the explanation of benefits provided in the portal.
- I work with programs such as Waystar clearing house, Groupcast Document Imaging (GDI), Centricity Business (CB) and provider portals.
- My goal is 60-80 claims per day.
- Maintain knowledge of insurance rejection/denial processing.
- Comply with state and federal laws and regulations for Commercial, Medicare, Medicaid, Managed Care and self-pay payers.
- Perform special assignments and other related tasks as assigned.
Grievance Appeals Specialist
Molina Healthcare
01.2013 - 01.2017
- As part of the Appeals and Grievances team I have been able to see multiple facets when it comes to concerns our members have. As a coordinator I was able to research and provide a response to the member’s concerns.
- I was also tasked with handling expedited grievances that our members would face. For expedited grievances, I was given 3 business days to provide a resolution to our members. These expedited grievances dealt with a large range of concerns.
- During my time in Appeals and Grievances I was able to learn how to handle multiple tasks at the same time. I had different time frames for each case and provided responses for these cases in a timely manner. Sense of urgency is key to all of my deliverables.
Asst. Manager
Mother’s Nutritional Centre
01.2003 - 01.2012
- As an Assistant Manager I was in charge of placing product, as well as supervising a team of 2 or more. Part of my position was to teach my team the tools that made our store run properly. I have learned how to think quickly on my feet in order to accommodate our customers and be as professional as possible.
Education
Associate of Arts - Computer Information Technology
San Bernardino Valley College
San Bernardino, CA05-2028
A-Technical College - Health Information Technology
A-Technical College
04-2018
Skills
- Proficient in Microsoft Office Operating Systems
- Bilingual in Spanish
- Meticulous Attention to Detail
- Excellent Time Management
- Resourceful and Partnering
- High Awareness of Compliance
- Leadership skills
- HIPAA/Patient Confidentiality
- Electronic Health Records
- Typing Skills 70 WPM
- Medical Billing
- Customer Service Oriented
- Data Entry
Timeline
Claims Representative
Amplus Group
01.2019 - 2021
Claims Representative
Team Health
01.2018 - 01.2019
Grievance Appeals Specialist
Molina Healthcare
01.2013 - 01.2017
Asst. Manager
Mother’s Nutritional Centre
01.2003 - 01.2012
Analyst, Config Info Mgmt
Molina Healthcare
2021 - 2024
Associate of Arts - Computer Information Technology
San Bernardino Valley College
A-Technical College - Health Information Technology
A-Technical College