Paloma Gonzalez
Sherman Oaks
Summary
As a Claims Auditor my daily work includes reviewing paid, denied and pending claims to ensure accuracy.
Conducting audits to verify that claims adhere to contracts,policies and financial responsibility, Ensuring correct reimbursement rates.
Error detection, identifying overpayment, underlayment or duplicate charges. Adjudication of claims if needed to maintain timeliness. COB claims processing.
Overview
15
15
years of professional experience
Work History
Claims Auditor
MEDPOINT MANAGEMENT
Sherman Oaks
01.2011 - Current
- Conducted audits on claims processing for accuracy and completeness.
- Collaborated with staff to resolve claim-related issues efficiently.
- Provided recommendations for corrective action on identified issues from audits.
- Prioritized daily tasks to complete workloads within department's expected timeframe.
Education
Bryman College
Reseda , CACanoga Park High School
Canoga Park, CASkills
Medical Coding and Terminology: Proficiency in standardized Coding systems such as ICD-10 (International Classification of Diseases) CPT (Current Procedural Terminology), and HCPCS
Regulatory Knowledge: Deep understanding of healthcare laws and guidelines, including HIPPA privacy rules and CMS regulations
Software Proficiency:Expertise in using EZCAP, Smartsheet and Excel
Attention to Detail
Analytical Thinking
Communication Skills and time Management
DOFR verification
Knowledge of CCS (California Children Services
COB claims
LOB Medi-Cal, Commercial and MEDICARE
Timeline
Claims Auditor
MEDPOINT MANAGEMENT
01.2011 - Current
Bryman College
Canoga Park High School