claims provider relations
Resume:
SUMMARY
SKILLS
EXPERIENCE
MONICA
JARAMILLO
**********@******.***
Miami, FL 33176
Driven to promote customer satisfaction through personalized and knowledgeable support for different requirements. Self-directed in investigating and resolving inquiries. Demonstrated skills in meeting and surpassing productivity targets. Experienced call center professional trained in insurance policies, plans and coverage limitations. Remains calm and level- headed in fast-paced environments. Solves problems independently and teaches providers to use electronic systems. High-performing and systematic with excellent organizational and analytical abilities with focus on promoting loyalty. Gifted communicator, conflict manager and relationship builder successful at offering providers positive and seamless experiences. Hardworking, conscientious and resourceful team player. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience.
• Account Development and Networking
• Claims Reviewing
• Claims Resolution
• Billing Discrepancy
• Client Relationship Management
• Microsoft Office
• Event Logistics
• Customer Service
• Team Collaboration
SYSTEM CONFIGURATION ADMINISTRATOR 11/2022 to Current Independent Living Systems, ILS - Miami, FL
• Assisted in the development of new administrative systems, procedures and policies.
• Prepared reports on various projects for management review.
• Developed spreadsheets to track project progress, budgets and other related data.
• Conducted research on requested topics using reliable sources.
• Ensured that all paperwork was completed accurately before submission deadlines. Designed forms and templates to streamline workflow processes within the organization.
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Researched and developed administrative policies, procedures and guidelines to facilitate operations.
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• Maintained positive working relationship with fellow staff and management. Utilized document management system to organize company files, keeping up-to-date and easily accessible data.
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PROVIDER RELATIONS COORDINATOR 11/2021 to Current ILS - Miami, FL
Managed provider data updates, including contact information and credentialing status.
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Developed and maintained relationships with providers to ensure compliance with contractual obligations.
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• Coordinated provider network meetings, events and trainings.
• Reviewed and processed new provider applications. Conducted regular outreach activities to promote services offered by the organization.
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Resolved provider inquiries and issues related to reimbursement, claims processing and other operational matters.
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• Communicated changes in policies and procedures to providers as needed.
• Provided technical assistance to providers regarding electronic transactions such as EDUCATION AND
TRAINING
REFERENCES
claims submission or payment inquiry requests.
Compiled monthly activity reports detailing progress achieved towards objectives set forth in the contract agreement.
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Tracked regulatory changes that may affect provider relations processes or protocols.
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Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues.
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• Investigated concerns such as billing and claims questions on behalf of providers. CLAIMS ADVOCATE 11/2019 to Current
ILS - Miami, FL
• Investigated and documented claims to determine eligibility for coverage.
• Obtained medical records, bills, and other related documents to process claims.
• Researched policy provisions and applicable laws to verify coverage under policies.
• Assessed the validity of claims based on established criteria and procedures.
• Reviewed claims denials for accuracy prior to issuing final decisions. Advised clients on claim status updates as well as their rights and responsibilities under their policies.
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• Ensured compliance with all relevant regulations governing the processing of claims.
• Processed appeals in a timely manner according to company standards. Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
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Fairfax Senior High School - Los Angeles, CA
High School Diploma
06/1987
LACC - Los Angeles, CA
General Studies
References available upon request.
Contact this candidate