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.
