Credentialing Specialist at Partnership HealthPlan of California — TEKsystems (2025-04 – Present)
- Coordinate provider credentialing and recredentialing activities for Medi-Cal providers.
- Perform primary source verification using federal, state, licensing board, and other approved resources.
- Maintain accurate provider records in accordance with NCQA and DHCS standards.
- Conduct sanction screenings and verify provider information through NPPES and CCS databases.
- Review credentialing documentation to ensure completeness, accuracy, and timely processing.
- Support compliance by maintaining accurate and up-to-date provider credentialing information.
Revenue Cycle Specialist at Eating Recovery Center (2022-06 – 2025-02)
- Process patient charges and insurance payments accurately and efficiently.
- Follow up on outstanding insurance claims to support timely reimbursement.
- Perform daily balancing and close day sheets to maintain accurate financial records.
- Communicate with insurance carriers to research and resolve billing and payment discrepancies.
- Review account information and payment activity to identify and resolve issues affecting reimbursement.
Medical Claims Auditor at Foundation for Medical Care (2021-02 – 2021-10)
- Audit HMO and medical claims for coding accuracy, payment accuracy, and compliance.
- Review medical records and supporting documentation for adherence to federal regulations and industry standards.
- Research unlisted CPT codes to determine appropriate pricing methodologies.
- Perform daily verification audits to identify potential errors and maintain claims accuracy.
- Review claims documentation and coding information to support accurate payment decisions.
Billing Specialist at Aerotek (2020-06 – 2021-02)
- Process commercial and HMO insurance claims in accordance with payer requirements.
- Collaborate with coding and payment posting teams to investigate and resolve claims issues.
- Submit and monitor claims appeals when additional review or reimbursement action is required.
- Review patient and insurance balances to identify billing discrepancies and maintain account accuracy.
- Assist patients with payment arrangements and account resolution options.
Reimbursement Specialist at Kaweah Delta Hospital (2019-12 – 2020-04)
- Process Medicare, Medicaid, commercial, and HMO insurance claims.
- Identify reimbursement variances and underpayments requiring further investigation.
- Submit appeals to support accurate reimbursement in accordance with contractual agreements.
- Maintain compliance with payer-specific billing and reimbursement requirements.
- Review claim payment information to identify discrepancies and support appropriate resolution.
Lead Commercial Claims Analyst at Foundation for Medical Care (2017-03 – 2019-03)
- Process HMO claims for patients assigned to Key Medical Group.
- Assist providers and patients with claims-related questions and issue resolution.
- Serve as a resource for team members regarding commercial claims processing procedures.
- Review claims using SYMKEY to verify accuracy prior to payment authorization.
- Support team members with claims research and resolution of complex processing issues.
Claims Processor at Cigna (2015-07 – 2017-03)
- Process international medical and dental claims accurately and efficiently.
- Review claim documentation to ensure compliance with payer guidelines and claim requirements.
- Maintain productivity and quality standards while managing high-volume claim workloads.
- Review supporting documentation to determine appropriate claim processing and payment.
Administrative Medical Assistant at Milan Institute (2011-04)
