Shirley Duarte
Wildomar
Summary
Highly organized professional with proven track records in coordination complex tasks ,Outgoing and detailed-oriented. I am proficient at building and maintaining professional relationships. I am able to work in a fast pace, high stress environment without a problem. I consider myself a patient/member advocate and will always strive to give everyone the same quality care.
Overview
11
11
years of professional experience
Work History
Coordinator/Claims Analyst
Prospect Medical
03.2017 - Current
- Validate claims submitted and match correct progress notes ensuring coding accuracy and completeness
- Maintain productivity standards
- Back out erroneous claims
- Retrieved Annual Wellness Visits sent from provider
- Educated provider on documentation
- Send request for audits for medical records
- Interacted with network managers regarding annual Wellness visit
- Answered doctors calls for any question they had regarding Annual Wellness visits or Documentation
- Programs used Microsoft Word, Excel, and IDX
HCC Coordinator
Prospect Medical
01.2014 - 01.2017
- Retrieved Annual Wellness Visits sent from provider from inbox and Email on computer
- Made sure Annual Wellness Visit were in the correct Folder to be sent to coders
- Send request for audits for medical records
- Interacted with network managers regarding Annual Wellness visit
- Answered doctors calls for any question they had regarding Annual Wellness visits
- Programs used Microsoft Word, Excel, and IDX
Medical Assistant
Prospect Medical
12.2015 - 01.2017
- Answer phones, make phone calls to insurance to check eligibility or check online
- Collect copays from patient and log it in
- EMR scheduling for 3 different doctors
- Answered 4 different phone lines
- Room patients, take vitals sign and log it in to system
- Put patient on Vax-D machine and Hako
- Schedule patients for all assessment needs
Education
Bachelor’s Degree - Human Services
Cal State Fullerton
01.2023
A.A Liberal Arts Degree - Human Services/Social Worker Major
Cypress College
Cypress, CA05.2020
Medical Assistant Program - Medical Billing and Coding
American Career College
Anaheim, CA03.2012
Skills
- Fluent Spanish Speaker
- Referral Investigation
- Excellent Customer Service
- Family Assessments
- Teamwork Strategies
- Phone / Mail / Email Skills
- Internet Research Platforms
- Detail Oriented / Multi-Tasking
- Decision-making
- Work Planning and Prioritization
- Presenting ideas and plans
Languages
Spanish
Native or Bilingual
Timeline
Coordinator/Claims Analyst
Prospect Medical
03.2017 - Current
Medical Assistant
Prospect Medical
12.2015 - 01.2017
HCC Coordinator
Prospect Medical
01.2014 - 01.2017
A.A Liberal Arts Degree - Human Services/Social Worker Major
Cypress College
Bachelor’s Degree - Human Services
Cal State Fullerton
Medical Assistant Program - Medical Billing and Coding
American Career College
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