Insurance Specialist Claims Examiner

R O S A L B A G. DE R O B E R T I S

**D Island Boulevard, Bohemia, NY 11716

Email: ***************@*****.***

*** – 520 - 8428 (C)

Dynamic Associate with extensive experience in professional office management and medical account management field, utilizing my experience for efficient administrative service for professionals, in accounts payable, patient billing, with an exemplary track record of providing excellent customer service for all. SKILLS: Account Management: Accounts Receivables/Payable, Adjudication of Medical Claims, All Microsoft Applications, Budget Plan Coordinator, Billing Expert, Credit Card Payment Processing, Compliance Underwriter/Customer Service Associate, Excel Insurance Educator, Medical Billing, Medicare/Medicaid Educator, Phone Etiquette, Problem solver, Paralegal, Payment Posting, Reconciling Claims, Strong Analytical Spreadsheet skills, Time Management skills, Trainer, Troubleshooter, Web-Portal Savvy EDUCATION

Bachelor’s Degree State University of Albany, NY

CERTIFICATES

Paralegal Certificate Adelphi University, Garden City, NY Medical Billing Certificate Eastern Suffolk Boces, Bellport, NY WORK EXPERIENCE

FULL-TIME EMPLOYMENT 08/19 Presently

STONY BROOK CLINICAL PRACTICE MANAGEMENT E. SETAUKET, NY SENIOR BILLING ASSOCIATE FOR PHYSICIANS BILLING

CURRENT

SELFPAY ADMINISTRATOR, SPECIALIZING IN MONEY MANAGEMENT ACCOUNTS SEPT. 2021

• Create Budget Payment Plans for patients that offer a reasonable payment amount to pay off their balances

• Educate and enroll patients in Stony Brook University Hospital’s Financial Assistance Program, where if patients who have a limited income, or are underinsured and have difficulty paying for services provided, they can apply for financial assistance and enroll to have once qualified a reduction in both Hospital bills and Physician bills

• Accurately setting up new clients in CENTRICITY/IDX SYSTEMS with client payment terms, billing rates and financial terms. Working with engagement team to make appropriate time and out of pocket shifts for billing.

• Ensure billing timelines are met, specifically those that are required by the Patient/constant phone contact

Send out weekly Accounts receivable reports to client contacts, ensuring bills are collected in a timely fashion

Demonstrate courteous and professional behavior when dealing with patients. SENIOR TELEPHONE-ASSOCIATE FOR PHYSICIANS BILLING AUG. 2019-AUG 2020

High telephone volume with Patients on billing discrepancies. Patient reconciliation on posting credits, taking payments, research on postings such as finding unapplied payments

Adjustments to Patient Billing problems, solver on inquiries, educator on medical plans

Handle prolific amounts of credit card transactions for Patients calling in to pay their bills; Health Saving account credit cards, VCard Mobile, E-Check Bank account deductions all via telephone

Collect/Print and mail itemized bill after a claim is reprocessed reflecting new charges on the invoice

Occasionally, assist Patient on pre-authorization; specifically educating Patients in contacting their Carriers for assistance to obtain approval for procedures done in a doctor’s office

On a regular basis, educated Patients on Medicare Deductible and their responsibility on invoices their disputing PLATINUM BENEFITS BROKERAGE BOHEMIA,NY 12/17-07/19 INSURANCE SPECIALIST

Brokerage Firm service insurance specialist duties included: contact with Executive Broker's accounts and renewal in healthcare coverage for their book of business; primarily health insurance

Processing health /dental insurance enrollment forms for existing accounts; compliance on HIPAA, review pre- existing regulations; the processing of student dependent forms/domestic partner, COBRA,

Responsible for supervising the billing/intake department operations; perform duties such as charge entry, payment posting, reimbursement referral intake and insurance verification, claim submissions, and accounts receivable, returning phone calls for Patient with inquires, resolution problem solving

Sales agent assistant, work phones, create quotes for office, daily explanation of various insurance policies and help clients choose plans that suit them

EMPLOYMENT AGENCY PLACEMENTS:

NORTH AMERICAN PARTNERS IN ANESTHESIA MELVILLE, NY 08/16-10/17 MEDICAL BILLER/REVENUE CYCLE MANAGEMENT

Established relationships with Insurance Carriers and Physician offices so to collect payments on past due bills. Created recommendations on payment plans. Organized list according to severity of delinquency.

Ability to multi-task and prioritized work, efficient in Microsoft Office programs

Development of office procedures which follow up with patients on balances and outstanding insurance claims

Appealed insufficient account balances for physicians and research denials from Insurance Carriers

Completion of claims to Carriers. Identified and billed Secondary/Tertiary insurances and payment posting PARTNERS HEALTH PLANS/HEALTHSMART HAUPPAUGE, NY 02/15-08/16 CLAIMS EXAMINER/PROVIDER SERVICES REPRESENTATIVE

Proficient in the adjudication/processing of FIDA-IDD medical claims, ability to interpret claims. Reconciling claims/re-pricing & denials of claims, Processed UB04 hospital billing

Assisted Providers on obtaining requests for eligibility/authorizations for plan for members

Reconciled balances, assisted providers by verifying claim payments with Vendor V-Pay

Billed for center on Individuals with Developmental disabilities, on traditional Medicare and Medicaid for providers on Outpatient Medical visits and therapeutic services; expert in Medicare/Medicaid Eligibility website, NYS Epaces

WALDORF RISK SOLUTIONS INC. HUNTINGTON, NY 12/11-11/14 ACCOUNT MANAGER/BILLING PRACTICE

Managed a Self-funded Insurance account for a twelve community property (over 1500 members)

Processed 1500 CMS medical claim forms(300 claims weekly) on the Multiplan Electronic Claims Systems

Insurance verification, contact with Carriers for information on health plan design Notified provider or supplier of service that their claim cannot be processed, due to incomplete information.

Responsible for carrying out analysis of trends affecting coding and accounts receivable

Set Up collection budget plans and assign manageable tasks to billing staff

Ensure the billing / intake department carries out all its activities in accordance with its overall protocol, and also that they complied with payer, New York State and Federal requirements, regulations and guidelines

Collaborate with other departments to get and analyze additional information about patients to be able to record and process billing effectively

In charge of coordinating time away requests of team members to ensure the daily functions of the department is not negatively affected

Drafted EOBs on services for members along with anesthesia billing. Submitted reimbursement for Patients

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