CONTACT

ad24wp@r.postjobfree.com

347-***-****

Bronx, NY 10454

ELIZABETH TAVERAS

PROFILE

Administration professional delivering superior customer experience. Extensive background in healthcare billing, collections, insurance and correlating systems. Fluent in Spanish.

WORK EXPERIENCE

Conifer Health Solutions

Denial Specialist 11/21-04/22

Research/Resolve claims and update management care system

(IMaCS); initiate appeals to resolve disputes per contract terms by payor, managing leadership escalations, incl. denials and payment variances, as needed. Coordinate clinical consults and account referrals with clinical resource center; facilitate special projects on payor contracts, interpreting terms and compiling documentation for appeals. Expedite adjudication issues and refund referrals; implement corrective action to ensure accurate account coding in DCM system. Memorial Sloan Kettering Cancer Center

Foreign Financial Counselor 07/06-01/20

Managed benefits/billing/payments for international patients and expats. Prepared denied insurance analysis letters for patients to forward to insurance providers at their home countries. Advised parents of pediatric patients on out-of-network HMO guidelines and how to work with physicians to obtain authorization approvals. Consulted/advised parents on large balance settlements for their children’s medical services. Addressed member inquiries and concerns involving registration, enrollment, claims, benefit interpretation, referrals and authorizations for medical care.

Chemo/BVS Representative 07/05-07/06

Managed authorization requests for high-dollar chemotherapy, upcoming inpatient admissions and urgent care. Handled patient payments and financial assistance for non-covered chemotherapy treatments. Verified that approved chemotherapy services had not exceeded approved amounts; submitted clinical documentation to extend treatment as needed. Advised patients about their denied authorizations or delays in treatment due to insurance issues. EDUCATION

Associate Degree –

Computer Science

Monroe College

Bronx, NY 1989

SKILLS

• Healthcare

Management Systems:

o EPIC

o Filenet

o Ram

o Omnipro

o Epaces

o SMS

• IBM PC 486 with

system #34 & #36 for

accounts payable and

receivable

• Microsoft Office Suite

ELIZABETH TAVERAS (CONT.)

WORK EXPERIENCE

Memorial Sloan Kettering Cancer Center (Cont.)

Insurance Follow-up Representative 12/03-06/05

Verified patient insurance coverage and benefits. Worked daily and monthly workload, referral, and credit reports. Updated patient accounts to minimize coordination of benefit (COB) denials. Entered insurance updates in smart card system for follow-up and review. Reviewed accounts to ensure proper billing. Assisted patients with insurance benefit inquiries and resolution of COB issues. Group Leader 10/00-10/03

Trained team on resolution procedures for complex billing and collection claims. Provided team guidance on difficult and complex patient and insurance provider inquiries. Reviewed accounts for collection eligibility. Worked weekly financial reports to resolve balances with insurance providers. Prepared account analysis reports for patients and legal representatives.

Collector / Follow up representative 09/98-09/00 Assessed accounts for collection. Reviewed smart card messages for accurate payments/recaps. Created refunds, internal requests, and write-offs to resolve balances. Ensured timely claims billing. Resolved denied and rejected claims. Contacted patients to remediate insurance, balance, and coordination of benefits issues. Prepared account analysis reports. Verified patient insurance billing eligibility. Responded to patient/ insurance provider inquiries. Biller 09/97-09/98

Ensured accurate data entry of charges, payments and adjustments into billing systems including postings to manual records. Correct patient registration, demographic and insurance data. Secured maximum claims reimbursements for patients from their insurance carriers for medical treatment received.

OTHER WORK EXPERIENCE

Data Entry Clerk: Finkelstein Borah Schwartz & Goldstein 06/94-02/97 Data Entry Coordinator: Chaiken Systems 07/90-06/94 Legal Administrative Assistant: Sheila E. Small 08/89-06/90