PAYENG YANG
Sacramento
Summary
Committed to ensuring the highest level of patient safety by meticulously handling and sterilizing medical instruments. Eager to be a valuable member of a healthcare team in delivering top-notch care and providing exceptional care driven by my commitment to quality and compliance.
Overview
12
12
years of professional experience
Work History
Internal Auditor
Liberty Dental Plan
08.2021 - 11.2023
- Examine and assess claims data to verify the accuracy of processing and adherence to service standards at the individual, group, and organizational levels. Evaluate and confirm the configuration of groups, including benefit schedules and frequencies, to guarantee that claims are processed correctly in accordance with the group's contract. Review provider compensation schedules integrated into the system to ensure alignment of procedure codes and monetary amounts with the terms of signed agreements. Investigate, document, and analyze audit findings to detect patterns and communicate them to relevant departments for training initiatives. Coordinate with the appropriate departments to ensure timely implementation of necessary corrections. Foster a safe and efficient working environment by adhering to established protocols.
Senior Claims Analysis
Avesis, Premier Access, Access Dental Insurance
03.2020 - 08.2021
- Primary point of contact for claims and utilization management issues related to the Dental Department. Serve as a backup auditor and trainer as needed, contributing to the training and development of newly hired associates and providing upskilling for current team members. Manage referrals, claims, and preauthorizations. Engage in special projects aimed at improving efficiency, including testing system modifications to ensure precise processing and outcomes. Evaluate procedures to confirm the implementation of accurate logic. Possess extensive knowledge of diagnostic and procedural coding for dental claims. Address complex and non-routine claims that necessitate a high-level review. Investigate and resolve claims, preauthorization, and referral issues from both internal and external customers promptly. Support the manager in addressing aged claims and managing claims adjustment projects. Execute all responsibilities in accordance with established standards, demonstrating a solid understanding of all business lines. Adhere consistently to all company policies and procedures. Capable of meeting or surpassing quality, accuracy, and production standards as defined by Premier/Avesis.
Claim Analysis
Avesis, Premier Access, Access Dental Insurance
12.2016 - 03.2020
- Claim Analyst responsible for managing Government Claims (GMC/LAPHP) related to both the Statement of Actual Services and Requests for Preauthorization. Proficient in processing DHMO claims for the State of California. Engaged in special projects that are critical to business operations. Conducted audits on claims and prior authorizations to assess the productivity and financial quality of GMC/LAPHP claims processing. Handled the posting of refund checks.
Data Entry Specialist
Xerox
12.2015 - 12.2016
- Claim Processor for contractual services in Social Work Child Support Payments to guarantee precision and accurate billing details.
Shift Manager
Pizza Guys
10.2012 - 12.2015
- Train new staff, deliver exceptional customer service, respond to customer inquiries, and enhance the dining experience. Record data from the previous day's activities, oversee store operations, supervise team members, and delegate tasks to employees. Handle cash register operations and food management, monitor food and labor expenses, and manage inventory.
GEO Garden Worker
Workforce Investment Act (WIA)
08.2011 - 05.2012
- Guide elementary and middle school students, engage in gardening activities, oversee garden maintenance, ensure cleanliness, and collaborate effectively within a team.
Education
No Degree - Sterile Processing Technician/Scopes
Altamont Healthcare
Stockton, CA04-2025
Undergraduate -
California State University of Sacramento
Sacramento, CA01.2014
High School Diploma -
Grant Union High School
Sacramento, CA06.2012
Skills
- Excellent written/verbal/interpersonal communication skills
- Proficient in Microsoft Office, Excel, Word, Powerpoint
- Skilled in Task Management
- Meticulous and Adaptive Learner
- Positive Team Contributor
- Effective Client Interaction Skills
- Strategic Issue Management
- Skilled at Meeting Tight Deadlines
- Independent and Collaborative Work
- Trustworthy Execution
- Analytical Decision-Making
- Relevant Data Analysis
- Regulatory Compliance
- Quality assurance
- BLS/CPR AED
Certifications/Training
Basic Life Support/CPR Certified: 03/2025, Exp 03/2027
Zenith Career Services, American Heart Association - Stockton, CA
CSPDT/CFER Certification Exam: Expected 05/2025
Timeline
Internal Auditor
Liberty Dental Plan
08.2021 - 11.2023
Senior Claims Analysis
Avesis, Premier Access, Access Dental Insurance
03.2020 - 08.2021
Claim Analysis
Avesis, Premier Access, Access Dental Insurance
12.2016 - 03.2020
Data Entry Specialist
Xerox
12.2015 - 12.2016
Shift Manager
Pizza Guys
10.2012 - 12.2015
GEO Garden Worker
Workforce Investment Act (WIA)
08.2011 - 05.2012
High School Diploma -
Grant Union High School
No Degree - Sterile Processing Technician/Scopes
Altamont Healthcare
Undergraduate -
California State University of Sacramento
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