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Alexandra Saeteurn

Claims Appeals & Adjustment Processor

Skills

  • 10 Key
  • Typing 65-70 wpm  
  • Microsoft Office
  • Alpha/Numeric Filing
  • Anatomy / Physiology
  • Appointment Scheduling
  • Billing and Collections
  • Cash Handling
  • Bookkeeping
  • Claims Processing
  • HIPAA & OSHA Compliant
  • ICD-9 / CPT-4 Coding
  • Insurance Billing
  • Medical Records Management
  • Pharmacology
  • Vital Signs
  • HMO/PPO and other insurance
  • HCPCS
  • Bi-Lingual (Iu-Mienh)
  • Internet/ Social Media

Work experience

Jul 2014Present

Claims Processor

Xerox

West Sacramento, CA Weekly Claims Processor Claims & Adjustment processing for Medi-Cal

Basic mathematics for claims pricing Microsoft Office & Email proficient Weekly Claims processing Claims Manual Pricing Share of Cost Appeals & Adjustment Authenticated the information on all medical claims received Reviewed and made sure claim information is not missing Claim, eligibility, covered benefits and approval status issues Entered claims into computer utilizing knowledge of CPT, ICD-9 codes and medical terminology Read and assessed medical documents. Accurately evaluate, regulate, and pass judgment of Medi-Cal claims in a timely manner Reviewed electronic claims and processes data as required into the claims system, resolved computer generated correct conditions, and determined right payment

Dec 2013Jul 2014

Customer Service Representative

Maximus

AppleOne-placed at Folsom, CA Customer Service Representative(Contract)

Responsible for answering inbound calls regarding Obama Care/Covered Oregon and the various health insurance market place programs. Assisted customers with the enrollment process, browsing and deciphering various health plans, coverage's and tax credits. Outbound calls to follow up on enrollment applications and deadlines. Maryland Tech Support-provided customer service support for password resets, creating help desk tickets for email activations & password resets. Obama care California eligibility. Handled PHI documents with verifying documents received. Uploaded documents required in the correct field. Data entry Hawaii Health Connection-Hawaii Health Connector agent. Verified Medicaid denial codes as well as completing applications for Hawaii Health Connector. Escalation of logs for technical issues. Handled inbound and outbound calls. Assisted customers with enrollment process and deadlines. Data Entry Worked in ISO Certified environment Medi-Cal for Families billing department-check status of billing as well as answering any questions for their bill.

Mar 2013Jan 2014

Supervisor

Dairy Queen

Citrus Heights, CA Supervisor
Cash handling; open/closing store; training new employees; customer service Coram Health Care Rancho Cordova, CA

Oct 2013Nov 2013

Medical Office Specialist

Coram Health Care
Medical Office Specialist(Externship) Bill reviews and CMS-1500 clearance forms; created insurance adjustments; faxed/copied sensitive documents Completed collection phone calls; responsible for patient payments; filed patient records as needed. Data Entry

Education

Mar 2013Apr 2014

Diploma

Kaplan College

Medical Office Specialist

Aug 2006Jun 2009

High School Diploma

Foothill High School

High School Diploma

Certifications

Apr 2015Apr 2017

CPR AED Certified

National Health Care

CPR AED First Aid Program- Provider # 294697