Seanett Torres-Espinoza

Orange Park, FL *****

adsvg6@r.postjobfree.com

+1-904-***-****

Brief Background: Settled in Jacksonville in 11/2006 7 years of Banking Experience

Over 15 years of Health Insurance Experience

Over 18 years of Customer Service Experience

Results-oriented Biller Premium Consultant with excellent organization, communication and relationship-building skills. Accurate Billing Premium Consultant performs all aspects of medical billing, including charge entry, transmission, correction and resubmission. Offering 18 years of experience in working hand-in-hand with Client

Company Representatives to validate proper information concerning claims processing. Detail- oriented and helpful professional with expertise in resolving billing issues. As a Customer Service Representative reviewing claim denials etc.

Analytical-thinking Medical Customer Service Representative proudly offering over 18 years' experience in reviewing accounts and maintaining company records (Proper Documentation etc.). Driven professional with a background in medical terminology and coding knowledge.

Offering task prioritization expertise in fast-paced environments. Well-organized with 18 years of experience in the analization of over 40 insurance claims statuses per day. Talented at analyzing and validating patient information, diagnoses and billing data etc. As a Billing Premium Consultant acquired Skills in drafting invoices and resolving billing invoices disputes quickly. Proficient in Excel and Microsoft Programs. Multitasking Medical Customer Service Representative; with a career spent submitting claims of question quickly and efficiently assisting customers with secondary insurance submission to insurance companies. I am an individual with a can- do demeanor and a positive attitude.

Ready to tackle new challenges in an office-based environment and now to include Remote environment. Results driven professional with over 4 years of hands-on experience in account management and medical billing and coding knowledge. Accomplished in developing strategies to improve my workflows and processes, and actualizing procedures to enhance revenue generation. Demonstrated leadership skills guide in assisting coworkers when needed to assist in helping my team to meet goals towards success. I make it point to optimize performance and sustain organizational success by using my resources and (or) contacts established.

I understand medical terminology and medical billing codes. I have become successful at payment posting quickly and following up with clients. Adept at accounts receivable management and maintaining confidentiality. Quality-focused billing professional successful at settling patient and insurance accounts.

Detail-oriented Collector with multiple years of experience in billing area of my previous jobs. Committed to accurate reporting and maintaining multiple accounts at one time. Organized professional known for always adhering to data confidentiality and HIPAA regulations. Smart Medical Biller capable of performing all office duties with efficiency and undeniable detail. Thorough billing professional with great financial reporting account records management knowledge. Focused and industrious with drive to perpetuated over 20 years mission and values. Proven success in Customer Service and extensive knowledge of systems processes. Detailed Billing analyzation skills recognized for successfully batching, posting and matching invoices daily. Reliable and professional with 25 years of functional experience in providing clerical, administrative and financial services.

Analytical Customer Service professional with extensive experience. Meticulous Customer Service offering 20 years of comprehensive experience in Health Care and Finance. Comfortable working independently or as part of supportive team. Extensive familiarity of assisting Members in a professional manner while providing them with accurate information. Core competencies include researching complex scenarios and timely responses. Experience in eliminating errors, processing journal entries. Driven Billing Premium Consultant well-versed in day to day business operations. Skilled at increasing profits through account reconciliations to identify errors in calculations. Skilled at processing payments on outstanding invoices to minimize debt collections. Astute professional dedicated to verifying accuracy of information within ledger to verify accuracy of processed payments. Astute accounting professional well-versed in analyzing data to identify ways to aged items and improve accounting processes. Dedicated to reducing outstanding debt and avoiding additional fees. Long standing good attendance record.

Work Experience

Financial Representative

Baptist Health of Northeast Florida - Jacksonville, FL May 2022 to Present

Customer service: Post Payments, Set up Payment Arrangements, Analyze Accounts. Advise of Account Status; Assist with locating Insurance information and Update Account information. Perform task via the EPIC System. Work with other departments in order to request further assistance to the callers in medical claims being properly coded etc.

Financial Representative

Shand’s UF Health Jacksonville - Jacksonville, FL

March 2021 to Present

Job Functions: Register Patients to include; verify and update information currently on the system. Collect Financial responsibility according PT Medical plan benefits. Collects document signatures. Collect Run sheets via the Ambulance personnel. Clear work queues, Complete registrations of PTs whom are admitted.

Perform Direct Admit functions. Obtain Authorizations for inpatient stays via the insurance carrier website. Complete admission/registration process and other admission finance functions. Serves as liaison between patients, nurses, physicians and others. Responsible for handling walk-in patients and incoming telephone calls from in house customers seeking assistance with matters involving the patient accounting function. All functions performed on the Epic System. Trauma One experience. I am knowledgeable of admitting, billing and collection functions and is independently able to resolve many outstanding issues. Ultimate goal is providing excellent customer service. Billing Premium Consultant

Aetna insurance, CVS - Jacksonville, FL

January 2019 to December 2020

Job Functions: Account Maintenance. Provide Employers with accurate bills and ensure dues are finalized and money is collected and allocated across benefits and structure. Monitors, researches, and resolves collection of outstanding premium, overdue accounts, or revenue adjustment issues and reports corrections for coordinates collection and cancellation of overdue customers in accordance with pre- established market segment process. Create Manual invoices. FIS system. E-Billing research and Invoice production.

(Rating etc.) Ensures all manual adjustments, refunds, and write-offs are appropriately submitted, adhering to policy guidelines. Validates and updates Self Insured Revenue forecasting information and trends. Coordinates validation of eligibility

(List Bill and Summary Billing). Ensures that remittances are posted accurately across various Benefits and Account structure and reconciles customer remittances. Consults with internal/external customers to identify accurate account structure, billing format method and payment arrangements to meets customers' expectations. May negotiate and communicate change for non-standard products and/or services; evaluates customer billing requirements, customer payment arrangements and history to deliver a timely and technically accurate product. Researches, resolves and responds to product inquiries, i.e., revenue adjustment issues, from internal and external customers, e.g., Plan Sponsor, Member Services, third party vendor. Ensures that legislation and compliance has been properly adhered to regarding Plan Sponsor and/or Member activity. Utilizes and interprets online resources to understand customers account structure and benefits.

May assist with the development of such Resources, Monitors and Manages internal installation process, i.e., reports, to identify issues and ensures timely and accurate resolution to meet business goals and constituents' expectations.

Aetna Answer Team Aetna insurance (Now CVS).

Aetna Answer Team Representative

Aetna/CVS - Jacksonville, FL

May 2017 to January 2019

Eligibility Enrollment: Update and Corrections. Post group Premium payments, Insurance Plan upload and corrections. Research Discrepancies (Calling Provider Office or Heath care facilities etc.).

Assist Brokers and Group Representatives. Group Control Updates and Corrections. Assist Account Managers with varieties of issues. Performed by assisting both Company Rep and Broker Representatives professionals Health information request and claims processing information and by handling customer inquiries and assisting with problems via telephone, internet or written correspondence.

Customer inquiries are of basic and routine nature. Answers questions and resolves issues based on phone calls/letters from clients (plan sponsors and Brokers).

Triages resulting rework to appropriate staff.

Document and follow ups with members on concerns and request in Concerns pertaining to providers and plan sponsors on service request and account status. Explain member's rights and responsibilities in accordance with contract guidelines. Processes and verified claim referrals, new claim handoffs, nurse reviews, complaints

(Company Reps and Brokers), grievance and appeals via target system. Educates Clients on procedures and processes. Etc. Customer Service Representative

Aetna insurance, CVS - Jacksonville, FL

November 2013 to May 2018

Concierge Service Representative

Aetna insurance, CVS - Jacksonville, FL

October 2013 to May 2017

Job functions: Customer Service Representative Competencies is performed by assisting both Member and Medical professionals Health information request and claims processing information and by handling customer inquiries and assisting with problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature. Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Document and follow ups with members on concerns and request in Concerns pertaining to providers and plan sponsors on service request and account status. Explain member's rights and responsibilities in accordance with contract guidelines. Processes and verified claim referrals, new claim handoffs, nurse reviews, complaints

(member/provider), grievance and appeals (member/provider) via target system. Educates Members on our self-service options offered via Aetna Navigator website. Handles extensive file review requests.

Preparation and submit complaint and appeal. Assist in determent of medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.

Performs reviews of members claim history to ensure accurate tracking of benefit maximums, coinsurance and deductible.

Took some calls concerning Medicare inquiring about Appeals and Claims information Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.

Other duties to include: Performs financial data maintenance as necessary. Processing of payments and provide billing information via billing systems. Advise of plans being offered to Individual plan options. Advise of provider listing available via member area of interest. Also, experience with Government Accounts /Employer Accounts/ Market Place Accounts

(Obama Care).

Aetna systems that allows for accurate provision of information that is being provided to our Aetna members, such as; Claims status (ASD and EWMP), Billing (I ENROLL, E BILLING AND BILLER CONSOLE, GEMS, and BEARS) and Eligibility status (IOP, ECHS AND MEM). Also, additional systems not previously mentioned such as: ACAS, DMD, EPDB, ECHS, Web CCI, MEM, SCM, HMOPROD, CATS, Plan Sponsor Tool, AST, Claims X-ten, E-policy, IOP etc.

I have some knowledge of RX pricing etc.

Customer Service Representative

Aetna/CVS - Jacksonville, FL

November 2006 to October 2013

September 2013 to September 2013

In which, I have received some training in most areas of the Individual Dept. To better assist department members (Billing issues etc.). Concierges Representative

Aetna insurance (Now CVS).

Education

Bachelor of Arts in Business Administration

Florida State College - Jacksonville, FL

May 2014

Associate of Science in Business Administration

University of Maryland University College

May 2006

Medical Transcription

Mansfield Business College - N Charleston, SC

April 1993

Skills

• Claims

• Billing (I ENROLL, E BILLING AND BILLER

CONSOLE, GEMS, and BEARS) and Eligibility

status (IOP, ECHS AND MEM).

Perform work task using systems such as: ACAS

• EPDB (10+ years)

• ECHS (10+ years)

• Web CCI (10+ years)

• MEM

• SCM (10+ years)

• HMOPROD

• CATS

• Rumba

• Outlook (10+ years)

• People Soft (10+ years)

• Scan Documentation

for upload etc. EPIC system

Plan Sponsor Tool

• AST

• Claims X-ten (10+ years)

• E-policy

• IOP etc. Project Management I

• Accounting I (10+ years)

• Marketing

• Medical Terminology

• Medical Transcription

Business communication (10+ years)

• Business Law Knowledge.

Customer Service inquiries such as; Research Customer Service inquiries (10+ years)

• researching problems via Database (10+ years)

• Excel Spreadsheets (10+ years)

• Faxing (10+ years)

• HCPCS (10+ years)

• ICD-9 (10+ years)

• Hospital experience (3 years)

• Customer service (10+ years)

• Documentation review (10+ years)

• Medical records (10+ years)

• Typing (10+ years)

• Microsoft Outlook (10+ years)

• Analysis skills (10+ years)

• Microsoft Excel (10+ years)

• Microsoft Office (10+ years)

• Financial Report Writing (6 years)

• General Ledger Accounting

• Banking (8 years)

• CPT Coding

• Account Analysis

• Account Reconciliation

• Financial Services (10+ years)

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