Service Representative Patient
Resume:
Accomplished healthcare professional adept in claims processing, patient services, and workers' compensation. Proficient in utilizing digital resources for accurate claims management and successful appeals execution, as demonstrated during my tenure at Sutherland Healthcare. Recognized for crafting tailored payment plans and advocating for government-funded medical support as a Patient Service Representative at Monterey County Health Department Alisal Clinic. Seasoned in documentation, compliance, and confidentiality, with a proven track record in report generation and evidence collection from my role as a Workers Compensation Specialist at Central Coast Interpreters.
Claims Processing and Management: The ability to meticulously manage the claims process, including thorough online inquiries for accuracy and timeliness, dispatching appeal documents for denied claims, and categorizing payment details efficiently.
Financial Analysis and Payment Negotiation: Proficiency in evaluating patients' financial situations, devising customized payment plans, and advocating for individuals to access essential healthcare support, including government-funded programs.
Administrative Workflow and Documentation: Skill in streamlining administrative processes by assisting patients with important paperwork, generating professional correspondence, completing forms, and ensuring adherence to procedural guidelines.
Advocacy and Communication: Demonstrating effective communication by liaising with designated recipients to resolve claims, advocating for eligible patients to receive crucial medical care, and engaging in courtroom proceedings with persuasive evidence collection.
Data Analysis and Decision-making: Utilizing advanced digital resources to analyze claim statuses accurately, making informed decisions on claim processing, initiating evidence-based underpayment appeals, and determining eligibility for specialized payment programs. Sutherland Healthcare Mar 2022 – Jul 2022
Account management
Diligently engage in comprehensive online inquiries to ascertain the up-to-the-minute status of submitted claims, utilizing advanced digital resources to ensure accuracy and timeliness.
In instances where claims are denied due to capitated hospital responsibility or other payor obligations, execute the meticulous dispatch of LA DHS appeal documents in conjunction with the MCS letter to the designated recipients at Health net/LA Care.
Following the successful processing of claims and receipt of payment, meticulously extract, document, and categorize payment particulars. Claims falling within the 30–60-day payment window should be accurately labeled as 'payment in transit.'
In scenarios involving underpaid claims, proactively initiate underpayment appeals, substantiated by compelling evidence sourced from MCAL site or payor compass site. These appeals should be skillfully directed to LA Care/Health net.
Monterey County Health Department Alisal Clinic – Salinas, CA Dec 2020 – Mar 2022 Patient Service Representative
Evaluated the financial standing of patients and ascertained suitable payor channels, devising custom-tailored payment schedules; diligently pursued resolution of outstanding accounts.
Proficiently assessed and determined eligibility for specialized government-funded medical care payment programs, effectively advocating for eligible individuals to receive vital healthcare support.
Demonstrated a helpful approach by assisting patients in completing pivotal patient forms and consent documents, thereby streamlining administrative workflows and ensuring adherence to procedures. Central Coast Interpreters – Salinas, CA Jan 2015 – Jan 2019 Workers Compensation Specialist
Skillfully prepared a variety of professional correspondence, meticulously completed forms, and generated in-depth reports, contributing to the efficiency of the claims processing workflow.
Exercised a high level of discretion and responsibility in the management of confidential medical and workers' compensation records, aligning with stringent data protection regulations.
Engaged in the systematic collection of persuasive evidence aimed at reinforcing disputed claims during courtroom proceedings, underscoring the critical role in legal advocacy. Associate of Arts: Behavioural/Social Science – Hartnell College - Salinas, CA Jul 2016 Mirsa Ruiz
Mirsaruiz1986 yahoo.com
304 Sequoia St Salinas CA 93906
MR
CONTACT
Account Management
Claims Processing
Appeals Handling
Payment Reconciliation
Underpayment Resolution
Financial Evaluation
Payor Channels
Advocacy Support
Patient Forms
Workflow Streamlining
Eligibility Determination
Compensation Specialist
Record Management
Data Protection
Courtroom Advocacy
Financial Standing
Government Programs
Healthcare Advocacy
Administrative Workflows
Evidence Collection
Medical Records
Claims Documentation
Health Insurance
Confidential Management
Available upon request.
PROFILE SUMMARY
CORE COMPETENCIES
PROFESSIONAL WORK EXPERIENCE
AREAS OF EXPERTISE
REFERENCE
EDUCATION
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