Sandra I.

Henriquez
1425 W. Surrey Ave
Phoenix, AZ 85029
Home Phone (602) 564-0834
sh110dee4@westpost.net
OBJECTIVE: To use my knowledge of medical and hospital claims and coding, teachi
ng, and/or accounting background, as well as my research and analytical skill i
n some capacity of medical claims processing, appeals, analysis, billing, coding
, auditing or research
QUALIFICATIONS
--20 years experience in medical insurance claims
--Experience in higher level of decision-making (pricing high dollar claims, de
termining bundling and medical appropriateness).
--Detail-oriented, excelling at research, and identifying training issues; Organ
ized and can multi-task well
--Composed response letters to appeals; Excellent writing skills; Customer-ser
vice oriented
--Able to teach and train others; Strong leadership skills; I enjoy a challenge
.
--Communicated via telephone with providers and PPO vendors to resolve disputes;
Organized and can handle multiple tasks and deadlines.
EMPLOYMENT
2009-2011 Claims Analyst, National Health Benefits Corporation (NHBC)
--Searched through a bank of pricing networks to find the best discount for clai
ms submitted by TPAs
--Priced claims on networks' websites
2007-2009 SAM (Smart Audit Master) claims adjustor, United HealthCare
--Using SAM, identified if claim was paying correctly;. If not, adjusted claim
on UNET processing system
--Chosen to examine new edits for wording, and suggested changes for better comp
rehension by processors
--Created whiteboards as training tool
--Chosen to work more difficult, detailed edits, specializing in Medicare/COB/Me
dicaid
--Used Web-ex Teleconferencing
2006-2007 Research and Analysis, PacifiCare
--Appeals position. Received communication in writing or through Customer Servic
e, researched to determine if claim paid correctly
--Either adjusted the claim or sent a letter advising that it had been paid corr
ectly
--Worked both physiciansa and outpatient and inpatient facility claims
--Utilized Excel spreadsheets
2002-2006 Benefits Analyst (Appeals), Pacific Life & Annuity
--Responded to appeals via letter on Word
--Utilized Claimfacts, Solution Suite and Imageflo processing systems
--Worked various types of plans (small group, large group, ASO, fully insured, P
OS, EPO, HMO) and the administration of those plans, including co-pays, deductib
le, co-insurance and prior authorization, as well as coding (CPT, ICD-9 and HCPC
) and contracts and state and federal mandates. Checked for potentially fraudule
nt claims.
1994-2002 Technical Analyst, Pacific Life & Annuity
--Processed ASO, Medicare, COB and large and small group claims. Handled pre-exi
sting investigations
--As Technical Analyst, answered processorsa questions, read records to determin
e medical appropriateness, figured allowances for multiple surgeries, assistant
surgeons and other high dollar and contracted allowances
--Monitored ongoing DME rental to purchase, speech therapy, chiropractic/physica
l therapy files
--Released high dollar claims
--Presented training sessions on various aspects of claims processing

Henriquez page 2
1993-1994 Accounts Receivable Clerk, Smittyas Super Valu (grocery chain)
--Handled multiple vendors and types of accounts
--Dealt with buyers, managers, company representatives
--Paid claims and created reports (spreadsheet Lotus 1-2-3) on the computer
-- Met weekly, monthly and quarterly deadlines
1990-1993 Claims Processor, Blue Cross of Louisiana
--Processed Federal Employeesa claims, including coordination of benefits
1981-1987 Accounts Payable/Receivable Clerk, Smittyas Super Valu
--Paid invoices from simple grocery tickets to statements to purchase orders
-- Worked with buyers, sales representatives and store managers
--Worked the co-op advertising desk, dealing with the media and paying their bil
ls for the advertising
--Entered invoices and receipt documents online and created spreadsheets
1972 a"1979
--Music/Orchestra/Band Teacher in the Dysart Elementary School District (4 years
)
--Pioneered the String program in the Paradise Valley Unified School District (3
years)

EDUCATION
Bachelor of Arts in Education, Arizona State University
Master of Arts in Church Music, Oral Roberts University