Josue Baez Vigil

Analytical, knowledgeable of diagnosis, treatment and techniques to handle surgical instruments and tools during operating procedures. Claims processing, CPT, ICD-9, ICD-10 knowledge. Responsible, motivated and Fast Learner decision-maker. Excellent communications skills in Spanish and English.

Claims Analyst - MCS Health Plans - San Juan, PR

(2025-01 - 2026-01)

• End to end claims analysis
• Work with assigned claims assign by supervisor
• CAS claims
• Ensure cero expire claims daily

Claims Review Representative 3 - Humana Health Plans - San Juan, PR

(2022-01 - 2023-12)

• End to end claims analyst
• Work with assigned claims

Claims Auditor/ Analyst and Adjuster Claims - MMM Holdings

(2016-01 - 2021-12)

• End to end claims analysis
• Pre-pay M i Salud Claims
• Work with assigned claims assign by supervisor
• PM HS/CAS claims
• Ensure cero expire claims daily
• Participate in different staff meeting to ensure doubts are clarify
• Research background information for individuals under investigation
• Research and identify best sources of information from which to gather evidence to support the investigation
• Research/communicate information regarding contracts, payment policies, and state and federal regulations pertaining to their assigned line of business
• Ability to clearly communicate the claims adjudication process

Operating Room Technician - Ashford Presbyterian Community Hospital - San Juan, PR

(2014-01 - 2015-12)

• Assisted physician in operating room to perform medical procedures.
• Managed complex reports ensuring full compliance requirements and tight deadlines.
• Communicated medical concepts to patients to facilitate understanding.
• Inspected operations and provided impeccable customer service.
• Engaged staff and team to create memorable experiences.
• Performed appropriate sterile and unterile procedures to ensure Quality in OR.
• Oversee patient's chart, consent forms, to review assigned operating room.
• Assessed comfort and safety measures to provide verbal and tactile reassurance to patient
• Read patient Medical record.
• Indicate correct CPT code for billing claims.
• Correct UB-04 claims form.

Operating Room Technician (Practice) - Hospital HIMA San Pablo - San Juan, PR

(2014-01 - 2014-12)

• Transported patients to Recovery Room
• Prioritized tasks for proper handling of Instruments to be handled to Surgeons
• Completed Durable Medical Equipment verification.
• Provided additional supplies needed during procedure, anticipating needs.
• Performed secured dressings, after incision closures.
• Maintained Quality Standards in OR to prepare for next patient.
• Read patient Medical record.
• Indicate correct CPT code for billing claims.
• Correct UB-04 claims form.

Certification - Operating Room Technician - Antilles College of Health