1. HELEN FLORES
4508 3rd Street #14 • La Mesa, CA • 91941 • (619) 961-9294 • helensalazar_240@yahoo.com
CAREER OBJECTIVE
Obtain a position within a firm or corporation, which utilizes my paralegal education, research and data
entry skills, auditing experience, and medical claims background.
SUMMARY OF QUALIFICATIONS
 Goal focused and detail oriented Claims Analyst with 16 years of experience in the healthcare
field
 Assist my team in meeting and exceeding production and quality goals
 Tolerant and flexible, adapts to changes very well
 Proven track record of accurately completing projects within demanding time frames,including
last minute projects
 Strong verbal and personal communication skills
 Excellent organization and prioritization skills
 Able to read and apply payor summaries, contracts, authorizations, & MOUs
 Hands on with in-network & out of network HMO & PPO claims, professional & facility claims,
and COB claims
EDUCATION
Associate ofApplied Science in Paralegal Studies February 2012
Kaplan University
 Practical Assignments:LegalMemorandum, Deposition Summaries, Document Drafting,
Interrogatories, PowerPoint presentation on the U.S. Courts, conducted a face to face interview.
PROFESSIONAL EXPERIENCE
American Specialty Health, San Diego, CA 2010-Present
Clinical Claims Analyst
 Increase team quality by researching, investigating, and solving complicated claims issues in
accordance with departmental and state policies and procedures while following HIPAA and PHI
guidelines, while meeting demanding timeframes and production standards
 Monitor and resolve group email for expedited complicated requests and projects for Client
Services
 Secondary point of contact for claims requests regarding Subpoenas, TPL,and PHI. Create
response letters to the attorneys.
 Update member eligibility records
 Experience in reading, interpreting, and applying provider contracts,payor summaries, and LOAs
MedRecovery Management, Buffalo, NY 2008 - 2010
Data Mining Analyst
 Obtained, interpreted, and loaded facility contracts into DCI
 Monitored and maintained department workload while developing and documenting operational
policies and procedures to identify software enhancements
 Identified, audited, and flagged overpayments made on facility claims
 Recovered millions of dollars in overpayments

2. HELEN FLORES
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Molina Healthcare,Albuquerque, NM 1998 – 2008
Provider Information Analyst/ Auditor/Processor
 Researched and prepared healthcare provider information and then loaded into and maintained on
a database
 Loaded non participating providers and facilities into the QNXT database
 Processed complex medical claims in a timely and accurate manner
 Made decisions regarding Health Care Insight’s findings and applied edits according to the
applicable Health Plan’s guidelines ensuring quality measures were met by reviewing all relevant
information and making sure claims were processed accurately and routed for adjustments when
needed
 Assisted with provider appeals of Health Care Insight's edits
 Entered data from HCFA, UB92, and various other forms into GBAS, QMACS,and QNXT
 Kept a log of daily incoming checks on an Excel spreadsheet
TECHNICAL PROFICIENCIES
 Lexus/Nexus
 Westlaw
 Microsoft Word
 PowerPoint
 Excel
 Microsoft Access
 GBAS/QMACS/QNXT
 DIAMOND/IHIS/CHIP
 Internet/Intranet Explorer
 Treasury Disbursement