Open to opportunities

jenise Rodriguez

@jeniserodriguez

Message

I am an experienced medical claims examiner specializing in billing, adjudication, and network repricing.

United States

Message

What I'm looking for

I seek a remote medical claims role focused on accurate adjudication, repricing, and compliance within a collaborative, detail-oriented team offering professional growth.

I am a detail-oriented medical claims examiner with over nine years of experience processing domestic and international claims, repricing via VCC, Multiplan, and First Health, and interpreting ICD-9/10 and CPT codes for accurate adjudication. I am bilingual in English and Spanish and consistently meet company quality and compliance standards while resolving complex claim issues.

I maintain provider database accuracy, liaise with affiliate PPOs to confirm pricing and contract compliance, and submit MIS requests for data anomalies and system updates. I seek remote opportunities where I can contribute to organizational goals and continue to grow professionally.

Experience

Work history, roles, and key accomplishments

Current

Medical Claims Examiner

Current

GMMI Inc.

Sep 2014 - Present (11 years 9 months)

Process domestic and international medical claims in accordance with client policies, repricing claims manually and via automated systems using VCC, Multiplan, and First Health. Review ICD-9/10 and CPT codes, resolve pricing discrepancies, and ensure compliance with QMP guidelines.

Multiplan First Health ICD 10 Coding PPO Pricing Logic

Administrative Assistant

United Collections Bureau

Jun 2010 - Jul 2014 (4 years 1 month)

Provided administrative support including data entry, report processing, and document preparation while drafting settlement communications and managing outgoing correspondence. Delivered timely email-based customer support to maintain accuracy and client satisfaction.

Data Entry document preparation Microsoft Word Microsoft Excel Email Communication Administrative Support

Operations Support Specialist

Bank of America

Feb 2005 - Jun 2010 (5 years 4 months)

Processed daily financial transactions, performed payment reconciliations, and investigated billing/payment disputes to ensure accurate account handling. Maintained and distributed monthly financial reports and bank statements for operations teams.

Billing Disputes Financial Reporting Microsoft Excel Compliance Operations Support

Customer Service Representative

Convergys

Feb 2002 - Feb 2005 (3 years)

Handled high-volume inbound customer service calls in a call center environment, following scripts and protocols to resolve issues efficiently. Maintained customer satisfaction through clear communication and effective problem-solving.

Call Center Customer Service Scripting Problem Solving Communication CRM Systems Time Management