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Insurance Customer Service

Location:
Weslaco, Texas, United States
Posted:
October 03, 2016

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Diana Ramirez

**** *. ********* **.

Weslaco, TX 78596

Phone: 956-***-****

Alt Phone: 956-***-****

Email: acwwbv@r.postjobfree.com

Work Experience

March 2016 – Current The Mars Group @ Doctors Hospital Renaissance Financial Assistance Counselor Edinburg, TX

Screen uninsured patient’s for potential eligibility for government assistance programs

Assist patients in completion of application process for State, Federal and County.

Submit completed application with required documentation to State and County Case Worker and follow up for approval/denial.

Once approval received update hospital system accordingly for billing.

Obtain and verify Private Medical Insurance.

August 2015- March 2016 South Texas Health System/Weslaco ER Weslaco, TX

Admissions Rep/Registrar

Perform patient registration functions by interviewing patient or responsible party to obtain identification and demographic information.

Verify insurance/other payer benefits and perform up front collections.

Determine eligibility and arranges for admission of patients to hospital following policies and procedures.

Obtain signatures of individual responsible for payment and explain hospital financial obligation.

May 2015 – July 2015 Superior Health Plan/Centene McAllen,TX

Program Coordinator Staffing Agency Temporary Assignment

Review members account for 2067 Form to be uploaded.

Contact assigned members nurse if form is missing and past due.

Once form uploaded review and contact nurse if corrections needed.

Transmit corrected 2067 Form to TMHP.

April 2014 - December 2014 Cardon Outreach Inc. @ South Texas Health Systems McAllen, TX

Patient Advocate

Screening hospital patient’s bedside for medical assistance eligibility program.

Assisted patients in completion of application processes for State, Federal, and private medical assistance. Completed & submitted forms and additional documents to appropriate agencies.

Maintained case notation & updated all applicable systems.

Served as a liaison between patients, hospital staff and outside agencies in order to facilitate eligibility processes by ensuring that patients are covered appropriately and hospitals receive the reimbursement to which they are entitled.

December 2012 – September 2013 DaVita Renal Care Rio Grande Valley

Insurance Counselor

Meet with new patients to discuss insurance assessment.

Assist patients in applying for government assistance programs. Medicare, Medicaid or other program.

Initiate appropriate and necessary paperwork ensuring least amount of patient and facility liability

Educate patient of financial rights and responsibilities

Provide high-level of customer service to patients to ensure patient needs are met

Act as a liaison between patients, facility teammates, billing office and the corporate office to resolve patient insurance issues and/or concerns: proactively establish relationships with patient

Identify, resolve or escalate issues (insurance, billing, and satisfaction) as appropriate for prompt and effective resolution

Assist patients in retaining or obtaining insurance coverage

Partner with Social Workers to maintain awareness of patient insurance questions

Compile monthly operations reviews on assigned patient portfolio

Review patient lists with Facility Administrators and teammates to identify potential patient insurance issues

Screening hospital patients for medical assistance eligibility program.

Assisted patients in completion of application processes for State, Federal, and private medical assistance. Completed & submitted forms and additional documents to appropriate agencies.

May 2004 – August 2012 Cardon Healthcare Inc. @ South Texas Health Systems McAllen, TX

Patient Advocate/Reimbursement Specialist

Maintained case notation & updated all applicable systems.

Served as a liaison between patients, hospital staff and outside agencies in order to facilitate eligibility processes by ensuring that patients are covered appropriately and hospitals receive the reimbursement to which they are entitled.

Billing – Update hospital system with Medicaid/Medicare, County Indigent, and Insurance certified information. Submit weekly spreadsheet to central business office with certified account information and correct insurance plan.

Pay Review – Run weekly pay review template. Review and submit valid Cardon payments to cash posting for monthly invoice. Review and approve preliminary and final invoice reports.

Audit – Manually audit active certified inventory. Provide discrepancies to Regional Manager. Work with CBO insurance collectors on accounts needing follow – up. Statused Hidalgo County accounts through their website.

Education

1980 Edcouch – Elsa High Elsa, TX

Computer skills

Experience with Data Entry

Operate routine office equipment...Scanner, printers, copiers, fax machine

Working knowledge of MS Office applications...Excel, Word

Able to navigate through web-based applications

Run macros/templates



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