Experience

All Care To You

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Project Executive

  • May 2019 - Present



A Flores Legend Marble and Granite

• Anaheim, California

• CEO

  • Jun 2007 - Present

  Operating family business - fabrication and installation company for tile and stone material. Indoor and outdoor custom design from kitchen counter-tops to living room floors. Operating family business - fabrication and installation company for tile and stone material. Indoor and outdoor custom design from kitchen counter-tops to living room floors.



Advanced Medical Management, Inc.

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Project Executive

  • Oct 2018 - Apr 2019

  Worked special projects on a case by case basis. Involved in-loading of claims and adjusting claims using EzCap Claims Adjudication. This process helped claims team speed up claims reprocessing.• Identified and helped resolve production problems such as encounters.• Consistently met deadlines and requirements for all production.• Supported management in developing and implementing policies and procedures.• Created SQL script for backend up.• Adjusted professional and hospital claims for correct processing for payment.• Trained other claims staff members on proper handling and evaluation of hospital claims.• Utilized administrative guidelines as a resource or to answer questions when processing medical claims.• Reviewed data, including provider coding information and reported services and ensured they were properly inputted.• Obtained MOR, MMR, RAPs/HCCdx monthly files and managed download documentation.• Worked with rejects and encounters working directly with health plan to identify errors. Show less

• Quality Control Specialist

  • Jan 2011 - Oct 2018

  Worked with various departments such as UM, Claims, Eligibility, Contracting and health plans by maintaining benefits in the system. Maintained update and input Co-Pay and Benefits information into EzCap System. Supported various projects that were tasked by manager. Audit claims to ensure Benefits are process correctly. Knowledgeable of the Health Plan DOFR.• Provides daily oversight of benefits. Input and update benefits for all Health plans and all IPAs’ lines of business.• Coordinated, documented and development projects. Assisted and supported different department inquiry with emails, and calling health plans to verified information.• Developed and implemented data integrity initiatives for all support system configuration including fee schedules, benefits and any other areas that support the effective operation of internal systems.• Communicated, monitored and audited processes and procedures necessary to achieve strategic objectives.• Knowledgeable of Health Plan web sites to obtain benefits information for members• Contacted Health Plans by phone to verified members benefits• Checked Eligibility at the same time while verified benefits• Performed variety of different tasks.• Administered and ensured timely completion of all projects. Performs other duties as necessary. Show less