Insurance Service

Nilsa M Nunez

***** ** ** *** . *****, Florida

305-***-**** . **************@*****.***

Additional Information

. Skills: Excellent communication and writing skills, ability to manage

multiple tasks with demonstrated efficiency, excellent ability to

resolve and identify issues, strong result oriented and organizational

skills.

Professional Experience

Psychcare, Inc, Miami, Florida April 2006 - Present

Claims Analyst

Audit 6% of daily process work. * Prepare yearly client audits. *Develop

and prepare duplicate claim payments report. *Responsible for the weekly

closing batch. *Research and process all claims grievances and appeals

within 30 days of receipt. *Process refunds payments and apply credit

memos. *Backup claims supervisor and assist the department manger as

needed. * prepare policies and procedures for all lines of business.

*Maintain current training manual and comply with all existing training as

needed.

Claims Examiner II

Process 100-300 physician and hospital claims for mental health, Substance

abuse, Government claims and Secondary payer with a 99.9% accuracy. Price

out of network claims utilizing Medicare physician calculator in addition

to CMS, 3M and DRG calculators. *Accurately adjudicate all types of

transportation claims. *Run 837 reporting of electronic claims submission.

Intake Coordinator

Answer 50-100 incoming calls daily from Members, providers and insurance

companies related to authorization of services for pre- service routine

outpatient services. *Triage request for urgent-emergent appointments

related to suicidal or substance abuse. *Verify benefits and input

demographic information into VIS. *Assist the claims dept. with the

transition of Medicaid expansion. * Research denials and assist with

department over flow as well as authorizations.

Curascript Pharmacy, Orlando, Florida January 2002 - July 2004

Team Lead

Audit authorizations and verification of insurance *Assist team members

with questions and customer complaints *Provide reports at close of day

with daily productivity

Admissions coordinator

Provide manage care functions such as insurance & eligibility Verification

*Obtain payer pre-authorization for injectable medications *Negotiate

letters of agreement for out of network providers Patient care coordinator

Education

University of Phoenix, Online education January 2014 - Present

Bachelor of Business in Management

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