High School Health

DENISE PEREZ

***************@*****.*** • 813-***-**** Home • 813-***-**** Cell

SUMMARY Proven perceptive ability; competitive and goal oriented; intelligent and

intuitively minded; well developed, mature and a quick learner.

1 PROFESSIONAL EXPERIENCE

• WellCare Health Plans Tampa, FL 2007- 2010

SR.BILLING ANALYST

• Performs timely reconciliation of individual/group accounts on a monthly basis

Initiates collection efforts for the recovery of outstanding balances.

• Accountable for maintenance of the respective reporting documents and submission of

updated information by the designated time-lines.

• Responsible for reporting accounts receivable and unearned revenues monthly for New York

and New York child health plus Medicaid and Medicare plans.

• OPERATIONS AUDITOR

• Conducted daily quality audit reviews of Institutional and Professional claims.

• Verify eligibility, enrollment, pricing and configuration contract loads for accuracy.

• Tracks and maintains quality results for appropriate distribution.

• Provide feedback through meetings/ presentations to other departments to help improve work

process.

• Communicates audit results in a structured report format. Identifies and quantifies issues and

recommend audit criteria to validate financial impact.

CarePlus Health Plans, Inc., Tampa, 2001 - 2005

COORDINATOR OF BENEFITS/SUBROGATION

• Coordinate research and collection efforts of third party liability and subrogation cases for

optimal recovery and appropriate payment.

• Responsible for internal and external communications to obtain information and/or verify data

as it relates to the COB/Subrogation cases, claims auditing and Utilization reporting.

CLAIMS AUDITOR

• Audited UB92 and HCFA Claims.

• Responsible for reviewing all Diagnostic Related Groups (DRG) Outlier Stoploss cases and

maintaining. daily reports.

• Conduct data for inpatient/outpatient/physician claim payment audits.

• Act as a key liaison between third party providers, Health Service Department (HSD) and

Finance department.

• Repriced inpatient claims that exceeded outlier threshold thru Medicare’s DRG Pricer.

• Calculated new catastrophic cases to be evaluated by HSD.

• Assisted RN with On-Site Audits to review medical records to recover overpayments.

EDUCATION Concorde Institutional-Insurance Coding Present

Sickels High School, Tampa, FL

SKILLS Microsoft Word, Excel (pivot tables, summary tables and sub totals),

Access, Outlook, IBM Lotus Notes, Accurint database, CSC System, Point

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REFERENCES

• Available upon request

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