jenise Rodriguez
@jeniserodriguez
I am an experienced medical claims examiner specializing in billing, adjudication, and network repricing.
United StatesWhat I'm looking for
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
Medical Claims Examiner
GMMI Inc.
Sep 2014 - Present (12 years)
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.
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.
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.
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.
Education
Degrees, certifications, and relevant coursework
jenise hasn't added their education
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Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
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