Destiny Flores
Long Beach
Summary
Medical Claims Specialist with over 5 years of experience processing high volumes of healthcare claims in fast paced production environments. Experienced in batching, scanning, and processing UB-04 and CMS-1500 claims with a high level of accuracy and efficiency. Skilled in identifying and routing appeals to the appropriate department for timely resolution, as well as auditing claims to detect and correct errors before submission. Recognized for exceptional attention to detail, accuracy, strong organizational skills and the ability to maintain productivity while meeting quality and turnaround standards.
Overview
6
6
years of professional experience
Work History
Team Coach - Capability Development
First Source
Long Beach, CA
09.2022 - 01.2026
- Audit medical records in Sympraxis to verify correct output type and ensure accuracy of user-entered information
- Review and apply updates to file processing procedures, communicating changes clearly to team members to maintain compliance and consistency
- Audit UB-04 and CMS-1500 claims to ensure accuracy and compliance with processing standards
- Review and audit each batch of claims to verify appeals are properly identified and removed
- Monitoring scanning processes to confirm appeals are not mistakenly scanned with regular claim
- Ensure timely processing by auditing scanned claims and verifying they are sent out without delay
- Audit appeals and grievances to ensure accurate classification between appeals and non appeals
- Perform quality control in Rapid Capture operations, ensuring scanning integrity and claim accuracy
- Verify critical member and provider information, including NPI, Member ID, Authorization number, state and member name, etc. for accuracy and completeness
- Uphold data accuracy and compliance standards throughout all stages of claims processing and auditing
- Collaborate with cross functional teams to escalate and correct discrepancies in documentation or routing
Clerk, Mailroom
First Source
Long Beach, CA
07.2021 - 09.2022
- Scanned CHC, Recon and Claims Net to proper files according by state and date
- Batched UB-04 and CMS- 1500 claims into batches quickly
- Prepped and batched claims into batches to scan
- Logged claim numbers and reject letters into excel spreadsheet
Clerk, Mailroom
Molina Healthcare
Long Beach, CA
02.2020 - 07.2021
- Carefully review all claims to ensure documentation is complete and meets processing criteria
- Used member search and QNXT to locate members and claims
- Located certified packages to ensure it has been delivered, batched and scanned
- Sorted and placed mail into mailboxes and post office boxes with high levels of accuracy
- Operated postage meters, mail sealers and labeling machines
- Supported staff on special assignments and projects
Macy’s
Torrance, CA
11.2019 - 01.2020
- Fulfillment, locating and picking merchandise for customers
- Obtaining merchandise under a time limit for customers
- Using technology as a way to fulfill customers needs
- Ensure all picked merchandise is delivered to the receiving area to be packed and shipped
- Packed merchandise properly in bags and boxes to be sent out for delivery
- Loading merchandise and scanning each item to ensure the right amount for the store
- Ensuring labels were printed and placed onto items being shipped
Education
Academics Diploma -
Mary Star of the Sea High School
San Pedro, CA01.2017
Skills
- Microsoft Office (Excel, Outlook, PowerPoint, Word)
- Excellent Communication
- Team Collaboration
- Time Management
- Organization
- Audit reporting
- Claims processing
- Data entry proficiency
Timeline
Team Coach - Capability Development
First Source
09.2022 - 01.2026
Clerk, Mailroom
First Source
07.2021 - 09.2022
Clerk, Mailroom
Molina Healthcare
02.2020 - 07.2021
Macy’s
11.2019 - 01.2020
Academics Diploma -
Mary Star of the Sea High School