MARIA TERESA VELASQUEZ
Chino
Summary
Seeking to obtain a position where I can utilize my extensive experience and grow professionally. Highly motivated employee with a desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
18
18
years of professional experience
Work History
CLAIMS EXAMINER I
ALTAMED
06.2023 - Current
- Process specialty claims for Medi-Cal line of business per provider's contract/ pricing agreements, applicable regulatory legislation/policies, and claims processing guidelines.
- Adjusted/adjudicated claims, reviewed services for accurate charges and utilized billing codes such as ICD-10, CPT, and authorization codes.
- Assist other medical groups/departments with processing claims.
- Managed workloads efficiently by prioritizing tasks based on urgency or importance.
CLAIMS EXAMINER II
NETWORK MEDICAL MANAGEMENT
04.2021 - 05.2023
- Process Medicare claims per the provider's contract/pricing agreements, applicable regulatory legislation/policies, and claims processing guidelines.
- Adjusted/adjudicated claims, reviewed services for accurate charges and utilized billing codes such as ICD-10, CPT, and authorization codes.
- Assist other medical groups/departments with processing claims.
CLAIMS EXAMINER III
SYNERMED INC
10.2015 - 03.2018
- Responsible for analyzing and adjudicating medical claims as it relates to managed medical care.
- Performed reconciliation payments and adjustments related to retroactive contract rates and fee schedule changes.
- Resolve claims payment issues/discrepancies and claims incidents/inquires presented via the Provider Dispute Resolution Process (PDR).
CUSTOMER SERVICES REP
SYNERMED INC
04.2008 - 09.2015
- Provide excellent customer service for all incoming calls to ensure an exceptional customer service experience.
- Received incoming calls from patients/members, member advocates, providers, and health plan representatives.
- Identified and resolved issues related to patient care services.
- Assisted in responding to inquiries regarding eligibility, authorization status, PCP changes, appeals/grievance intakes, and other miscellaneous inquires that arose.
- Made outbound follow-up calls as needed and set reasonable actionable expectations with callers.
Education
HIGH SCHOOL DIPLOMA -
EL MONTE HIGH SCHOOL
El Monte06.1996
Skills
- Spanish bilingual
- Ability to work independently
- Team player
- Proficient typing ability - 45 plus WPM
- Proficient in medical billing terminology
Timeline
CLAIMS EXAMINER I
ALTAMED
06.2023 - Current
CLAIMS EXAMINER II
NETWORK MEDICAL MANAGEMENT
04.2021 - 05.2023
CLAIMS EXAMINER III
SYNERMED INC
10.2015 - 03.2018
CUSTOMER SERVICES REP
SYNERMED INC
04.2008 - 09.2015
HIGH SCHOOL DIPLOMA -
EL MONTE HIGH SCHOOL