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Jessica Gomez

Jessica Gomez

New Job

Company

Tucson

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Carlson Ears Nose and Throat

Insurance Verification


Experience working in a Medical Billing Office:
• Creating Fee Sheets for patient charges based off of their insurance benefits
• Communicating to the patient’s what charges they may expect
• Responsible for making sure patient accounts are current by processing payments thru our credit card machine, sending out monthly statements, Final Demand Letters and/or setting up the account for collections
• Responsible for completing the monthly AR reports, as well as the bi-weekly open claims report
• Responsible for Insurance Verifications via telephone and internet
• Communicating with Supervisors, Peers, or Subordinates
• Making Decisions and Solving Problems
• Organizing, Planning, and Prioritizing Work
• Performing for or Working Directly with the Public
• Ability to schedule, reschedule and cancel patient’s appointment. Confirm patient appointments
• Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken

Aetna

Senior Claims Associate


Experience as a Medical Claim Specialist:
• Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
• Supervise claims adjusters to ensure that adjusters have followed proper methods
• Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies
• Resolve complex, severe exposure claims, using high service oriented file handling
• Pay and process claims within designated authority level
• Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments
• Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
• Knowledge of ICD-9-CM, ICD-10 and CPT coding guidelines, medical terminology.
• Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation
• Contact or interview claimants, doctors, medical specialists, or employers to get additional information
• Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis
• Report overpayments, underpayments, and other irregularities
• Prepare reports to be submitted to company's data processing department

Sears

CSR


Experience with Customer Service:
• Confer with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints
• Check to ensure that appropriate changes were made to resolve customers' problems
• Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
• Refer unresolved customer grievances to designated departments for further investigation
• Determine charges for services requested, collect deposits or payments, or arrange for billing
• Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers
• Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments
• Solicit sales of new or additional services or products
• Obtain and examine all relevant information to assess validity of complaints and to determine possible causes, such as extreme weather conditions that could increase utility bills
• Review claims adjustments with dealers, examining parts claimed to be defective, and approving or disapproving dealers' claims
Displays sensitivity, integrity, compassion and respect towards patients and family members
• Adheres to HIPPA regulations and to company privacy standards; protects patient confidentiality
• Communicating with Supervisors, Peers, or Subordinates
• Making Decisions and Solving Problems
• Organizing, Planning, and Prioritizing Work
• Performing for or Working Directly with the Public
• Ability to Coach and Develop Others

Desert View High School

High School Diploma