Linda Basurto

Detail-oriented Insurance Analyst and Claims Auditor with expertise in automated systems and plan benefit variations. Proven track record of resolving high volumes of claims through accurate analysis and classification. Experienced in verifying healthcare billing accuracy, negotiating payments, and assessing settlements, leading to enhanced efficiency in claims processing.

Strong analytical skills and in-depth knowledge of medical coding and healthcare regulations contribute to cost-effective outcomes for employers.

Claims Billing Specialist - Shift Billing - Remote

(2025-03 - 2025-09)

• Processed patient billing inquiries and resolved discrepancies efficiently.
• Reviewed and verified insurance claims for accuracy before submission.
• Maintained organized billing records using specialized software systems.
• Collaborated with healthcare providers to gather necessary billing information.
• Conducted regular audits of billing processes to ensure compliance standards.
• Worked with team members to identify and develop process improvements.
• Investigated incorrect billings and processed refunds as necessary.

Medical Biller - Hoag Memorial Hospital - Costa Mesa, California

(2024-05 - 2025-01)

• Processed medical claims using advanced billing software and systems.
• Reviewed patient accounts for accuracy and completeness before submission.
• Communicated with insurance companies to resolve billing discrepancies effectively.
• Coordinated with healthcare providers to gather necessary documentation for billing.

Medical Claims Examiner - Memorial Care Medical Group - Fountain Valley, CA

(2022-07 - 2024-01)

• Processed claims using the Epic system.
• Accurately processed large volume of medical claims every shift.
• Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
• Researched medical records to identify additional information needed for processing claims.
• Reviewed claims for accuracy before submitting for billing.
• Reduced loss ratios through fair and prompt processing of claims.
• Maintained updated knowledge of changes in healthcare regulations impacting claims processing.

Insurance Analyst - EBA&M Corporation - Irvine, CA

(2019-01 - 2022-06)

• Processed self-funded claims using GBAS.
• Executed adjustments utilizing Blue Cross System.
• Processed medical claims meeting key metrics on productivity, financial accuracy, and regulatory compliance.
• Confirmed patient eligibility and applied Coordination of Benefits guidelines by partnering with the Enrollment and Eligibility team.
• Interpreted and administered member benefits and contract terms with medical providers.
• Leveraged multiple fee schedules and payment terms such as FFS, case rates, exclusions, carve-outs, capitation, per diem, and stop loss in conjunction with health plans and Division of Financial Responsibility.
• Analyzed pending claims and solicited necessary information to resolve unclean or contested claims.
• Administered timely filing guidelines for contracted and non-contracted providers, rejecting claims submitted untimely.
• Resolved requests from providers, patients, and health plans on claims questions or issues.
• Excelled in processing complex claim types and contracts necessitating meticulous review and elevated accuracy.

Claims Auditor - Western Growers - Irvine, CA

(2015-08 - 2018-12)

• Processed claims for Self-funded accounts.
• Handled all customer service issues.
• Adjusted claims for overpayments and underpayments.

Medical Claims Examiner - Scan Health Plan - Long Beach, CA

(2009-12 - 2015-07)

• Customer Service for all groups which includes eligibility and benefits.
• Interpreted complex provider contracts.
• Calculated benefits from per diem, case rates and stop loss.
• Processed Medicare and Medicaid claims using CMS Pricing.
• Processed DRG payments.
• Processed all dialysis claims.

Medical Claims Examiner - Monarch Healthcare - Irvine, CA

(2007-11 - 2009-06)

• Worked on EZ Cap system.
• Provided customer service for all groups which included eligibility and benefits.
• Interacted with providers regarding claim status or other related issues as required.
• Inputted data into the system, maintaining accuracy of provider coding information and reported services.
• Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.

High School Diploma - General Education - Saddleback High School (1982-01) Santa Ana, CA