NILDA MONTEMAYOR Melbourne, Florida ad03xb@r.postjobfree.com 407-***-**** (C)

PROFESSIONAL EXPERIENCE

United Health Care Solutions-Independent Insurance Patient Advocate (April 2022 - Present)

● Help clients understand the different types of coverage available.

● Provide assistance in resolving insurance disputes, filing appeals, and reimbursements.

● Provide advice and services regarding their insurance coverage.

● Help clients understand the different types of coverage available.

● Assist and help navigate the complex insurance system.

● Submitting insurance claims for reimbursement and following up on claim status

● Exceptional customer service skills, strong attention to detail, and excellent problem-solving abilities.

● Working with providers to resolve any coding or billing discrepancies.

● Ability to provide patient education regarding the use of medical devices.

● Strong organizational and communication skills.

● Experience with electronic health records (EHRs).

Compass Health Agency-Medicare Specialist

(May 2021-March 2022)

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Verified insurance eligibility and determined the patient's financial responsibility after co-pays.

Collaborated with customers to verify changes in their insurance plans. Assisted with their priority needs when it has to do with their health. Determine and evaluate plans state-specific for the client.

Created techniques to assist in managing healthcare needs.

Assisted with medical concerns and developed strong customer relations using a customer-focused needs-based review process to educate the clients.

TTEC

(United Healthcare)-Benefits Advisor Client Specialist

(July 2020 – May 2021)

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Inform/advise patients with requests for Redetermination of coverage denials (appeals).

Perform Needs Analysis to determine Medicare’s Advantage and

Prescription Drug Plan options.

Able to perform in a fast pace/multi-task environment, while providing accurate documentation.

Ability to communicate well with a client with persuasive communication skills.

Willis

Towers Watson-Extend Health Medicare Specialist

(July 2018 – Jan 2020)

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Responsible for client analysis of their healthcare needs

● Strong communication skills in explaining how the plan works.

● Exercised the ability to work with little or no supervision and take initiative to complete work in a timely manner.

● Health insurance specialists also help clients understand their coverage, and file appeals, and dispute resolution.

● Responsible for helping to educate clients about their coverage, including the implications of different coverage levels and the regulations that govern insurance plans.

SI-Bone-Case Manager-Consultant (September 2019 – May 2020)

● Performed in-depth insurance verification with all payer sources.

● Responsible for processing all authorizations and coordinating all information needed to expedite the insurance authorization process.

● Responsible for coordinating peer-to-peer reviews and processing appeals resulting from authorization denials.

● Responsible for drafting sample Letters of Medical Necessity (LOMN) and /or appeal letters.

RespirTech–Customer Service Specialist-Consultant (2017-2018)

● Conducted patient negotiations for payment and settlements, including authorized discounts approved by insurance providers.

● Called insurance companies to verify denials and process insurance claim re-submissions.

● Billing, primary, and secondary claim submission, etc.

Aflac/The Assurance Group-Individual Agent (2013 - 2016)

● Health Insurance plans and Medicare Supplements.

● Contracted with 120 carriers for whole life, Term, Universal, and Accident Insurance.

Flowonix Medical–Customer Care Specialist – Consultant (2012-2013)

● Processed insurance Redetermination Appeals.

● Completed patient demographic/registration process in coordination with other departments.

● Conducted patient negotiations for payment and settlements, including authorized discounts approved by insurance providers.

● Responsible for all patient file documentation.

● Called insurance companies to verify denials and process insurance claim re-submissions.

● Assisted Account Receivables and collection process by processing all related correspondence and issuing collection letters associated with past due co-pays, deductibles, and patient balances.

● Billing, primary, and secondary claim submission, etc.

Celebration Health–Florida Hospital – Medical Assistance (2009-2012)

● Provided in-person quality care to patients, vital signs, including daily monitoring, recording, and evaluation of medical conditions - up to 20 patients daily.

● Contacted Insurance companies for prior authorization for invasive and non-invasive procedures.

● Responsible for back-office patient assistance and venipuncture.

● Managed electronic medical records with the Epic Care system. Coordinated the electronic transfer of information to local hospitals.

● Responsible for patient file documentation, including medical records and financial information.

Cardiac Care Services/Shivanand S. Karkal, M.D. - Medical Assistant /Procedure Nurse

(2001-2009)

● Responsible for patient care, diagnostic testing, catheterizations, patient monitoring, patient triage, pre-certification, and hospital procedures.

● Responsible for incoming new patients’ health history as well as full body physical assessments.

● Performed routine medical procedures such as minor surgeries, catheters, vaccinations, suture removal, and Venipuncture.

EDUCATION

VALENCIA COMMUNITY COLLEGE Orlando, Florida Associate of Science in Nursing (2004-2009) Completed first four semesters of nursing program.

TARRANT COMMUNITY COLLEGE Fort Worth, Texas

Associate of Science in Healthcare (2009-2010)

CERTIFICATIONS/SKILLS Certified Medical Assistant Certification No. 258078 (Florida) Life and Health Certification No. W170942 (Florida)

Computer Skills: Electronic Health Records (EHR), Microsoft Office Suite, and Insurance

Verification Systems.

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