Summary
Overview
Work History
Education
Skills
Websites
Timeline
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ALIYAH CASTRO

Shreveport

Summary

Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.

Overview

8
8
years of professional experience

Work History

Claims Analyst

Activus Connect LLC
10.2024 - Current
  • Processed and adjudicated medical claims in accordance with Department of Veterans Affairs (VA) and TriWest policies, ensuring timely and accurate reimbursements.
  • Reviewed and analyzed documentation to determine claim eligibility, benefit coverage, and correct coding for services rendered.
  • Investigated and resolved discrepancies, denials, and appeals, collaborating with providers and internal departments to ensure compliance, service quality, and resolution of complex claim issues.
  • Maintained up-to-date knowledge of TRICARE and VA healthcare programs, HIPAA regulations, and industry standards to ensure compliant claim handling.
  • Utilized claims processing software and internal systems (e.g., Facets, VA platforms) to track, update, and finalize claims within performance standards.
  • Participated in quality assurance initiatives and continuous training to enhance accuracy, reduce errors, and support team performance metrics.
  • Supported audits and reporting efforts by compiling documentation and data to ensure regulatory and contractual compliance.

Medical & Behavioral Health Scheduler

Activus Connect LLC
12.2023 - 10.2024
  • Coordinated and scheduled behavioral health appointments for patients, ensuring timely access to services and alignment with provider availability.
  • Managed a high-volume caseload of appointments and referrals, including initial consultations, follow-up visits, and therapy sessions, while maintaining a high level of customer service.
  • Worked closely with behavioral health providers to optimize scheduling, minimizing patient wait times and improving workflow efficiency.
  • Verified patient insurance and eligibility information to ensure coverage for services and resolve scheduling conflicts or issues related to insurance coverage.
  • Communicated with patients via phone, email, and secure messaging systems to confirm, reschedule, or cancel appointments, ensuring clear and compassionate communication.
  • Maintained accurate and up-to-date patient records, appointment details, and any special requirements in the scheduling system.

Customer Service Representative

Activus Connect LLC
12.2022 - 12.2023
  • Managed high-volume inbound calls and chat messages from Veterans, VA staff, and healthcare providers, addressing inquiries related to medical and behavioral health care authorizations, provider availability, claims status, and eligibility verification.
  • Utilized TriWest's Customer Relationship Management (CRM) systems and VA's Health Services Records Management (HSRM) systems to accurately document and track all interactions, ensuring compliance with HIPAA regulations and safeguarding Protected Health Information (PHI).
  • Achieved first-call resolution by effectively assessing and addressing caller needs, escalating complex issues to appropriate departments when necessary, and ensuring timely follow-up.
  • Collaborated with VA medical centers and healthcare providers to facilitate appointment scheduling for Veterans, enhancing access to care through the Community Care Network (CCN).
  • Consistently met or exceeded department performance metrics, including call and chat volume, schedule adherence, quality standards, and productivity targets.
  • Participated in cross-training and flexible assignments to support business needs and foster continuous professional development.

Business Intern/Assistant

Brilliant Book Clubs
09.2017 - 05.2021
  • Assist in daily operations and administrative tasks, supporting senior staff and ensuring office efficiency.
  • Conduct market research to inform business strategies and provide insights on industry trends and competitors.
  • Prepare reports, presentations, and client-facing materials for meetings and project updates.
  • Manage client databases and track financial tasks like invoicing, budgeting, and expenses.
  • Coordinate meetings, events, and schedules, ensuring smooth communication and logistics.
  • Support business development efforts, including lead generation, client outreach, and customer service.

Education

Bachelor of Science - Medical Technology

Northwestern State University of Louisiana
Natchitoches, LA
05.2028

Associate of Arts - General Studies

Valencia College
Orlando, FL
12.2024

Skills

  • Microsoft Office
  • Appointment Scheduling
  • Call Management
  • Medical Terminology
  • EHR Systems
  • Insurance Knowledge
  • Prior Authorization
  • Claims
  • Medical Billing/Coding
  • Documentation And Reporting
  • HIPAA
  • CRM Systems

Timeline

Claims Analyst

Activus Connect LLC
10.2024 - Current

Medical & Behavioral Health Scheduler

Activus Connect LLC
12.2023 - 10.2024

Customer Service Representative

Activus Connect LLC
12.2022 - 12.2023

Business Intern/Assistant

Brilliant Book Clubs
09.2017 - 05.2021

Bachelor of Science - Medical Technology

Northwestern State University of Louisiana

Associate of Arts - General Studies

Valencia College

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ALIYAH CASTRO