Dinetric Foli

Colorado Springs, CO

I am a skilled team player with a strong background in healthcare environments. I work well independently to handle assignments and am always ready to go beyond basic assignments. Quick learner with good computer abilities. I am a hardworking and reliable customer focused on going above and beyond to support the team and serve customers. Trained in Medical Insurance and offering top-notch customer service abilities. Motivated to continue to learn and grow as a Medical professional. Work Experience

Dental Receptionist/Dental Insurance Verifier

Comfort Dental - Colorado Springs, CO

May 2023 to Present

I register new patients according to established office protocols • verify and update patient information

• inform patients of dental office procedures and policy • maintain and manage patient records in compliance with privacy and security regulations • answer and manage incoming calls • schedule patient appointments • confirm upcoming appointments and recalls according to office protocol • arrange patient slips for next day appointments • organize referrals to other medical specialists • dispatch lab work appropriately • collect and receipt payments from patients at time of treatment • maintain a professional reception area • safeguard patient privacy and confidentiality Medicaid Eligibility Specialis/ Authorization

El Paso County - Colorado Springs, CO

January 2022 to Present

As an eligibility specialist is responsible for reviewing applicants' documents to verify their eligibility for qualifying for various organization programs. Eligibility specialists organize files accurately, communicate with other institutions for fact-checking, follow-up with the applicants for missing requirements, respond to the applicants' inquiries and concerns, and recommend alternatives, especially for financial assistance. An eligibility specialist must have excellent communication and record-keeping skills and extensive knowledge of the aid programs and company policies for processing applications.

• Interviews applicants/clients and assists them in understanding and completing all required eligibility paperwork.

• Verifies program and services eligibility factors by retrieving or confirming information from a variety of sources.

• Performs eligibility computations based upon client-provided and collateral information; determines the applicability of work registration requirements.

• Conducts client customer service reviews.

• Reviews cases for accuracy and completeness.

• Investigates and computes possible issuance errors; creates reports concerning circumstances, establishes claims, and restores lost benefits.

• Responds to client requests for appeals or administrative hearings, composes rebuttal letters, and attends hearings.

• Provides clients with information and referrals to community support services, childcare assistance, and other available resources to help facilitate a comprehensive solution to the client's circumstances.

• Answers the Customer Service Line (CSL) and/or consumer inquiries to assist with changes and questions about our services as needed.

• Participates in internal committees, training, workshops, and seminars.

• Assists with unassigned caseloads as needed.

• Performs other duties as required.

Logistics Coordinator

Medix Staffing-AFFINITY EMPOWERING - Chiacago, IL

June 2021 to Present

· Determined strategies to recover missed opportunities for pick-ups and deliveries.

· Assessed process failures to implement corrective actions.

· Established performance benchmarks and identified trend variances to communicate inefficiencies to management.

· Upgraded orders to expedite priority shipments.

· Created shipment assignments for carriers to meet client timelines.

· Managed rush orders and changes to meet client expectations.

· Documented carrier performance to compare service levels against contract requirements.

· Resolved and communicated transit delays to maximize satisfaction.

· Completed documentation to prevent shipment delays.

· Set up accounts and input contract terms to onboard new vendors.

· Identified equipment and supplies to add items to completed orders.

· Built and strengthened relationships with customer's key personnel involved in logistics activities.

· Carefully evaluated the needs of each customer and strategized plans to meet each requirement.

· Continuously reviewed the performance of the logistics operations against targets and service agreements.

COVID-19 Screener

Medix Staffiing-COVIDCHECK -COLORADO - Colorado Springs, CO June 2021 to Present

· Administered medical questionnaires to all visitors and personnel entering and departing job sites.

· Enforced rules pertaining to mask-wearing in designated areas of the job site.

· Provided masks, hand sanitizer, and other PPE to individuals entering monitored facilities.

· Managed proper sanitization of screening stations and other work areas, adhering closely to established procedures and standards.

· Utilized tympanic and oral thermometers to take and interpret patient temperatures according to manufacturer's instructions.

· Cleaned and calibrated equipment, devices, and instruments for reliable results in examinations.

· Coordinated patient movements to and from examination areas to maintain efficient office flow.

· Recognized patients' breathing problems, irritation, and signs of discomfort to report abnormalities to assigned doctors.

· Offered patients above-and-beyond support to improve comfort levels and compliance with procedures.

· Disinfected surfaces and equipment regularly to protect patients and staff from infection.

· Updated client records with the latest treatments and progress notes.

· Advised individuals of potential responses to positive test results, including quarantine requirements.

· Adhered to established protocols and reporting requirements in recording positive and negative cases.

· Prepared statistical reports to track and address positive detections and indicators of community spread.

· Recorded details of screening results in an organizational database with accuracy and appropriate follow-up.

· Enforced rules pertaining to mask-wearing in designated areas of the job site.

· Collected specimens from patients to use in diagnostic examinations and laboratory testing.

· Monitored thermal camera systems to detect individuals showing signs of fever.

· Updated client records with the latest treatments and progress notes. Medical Insurance Verification/Patient Access Specialist EviCore - Colorado Springs, CO

April 2010 to October 2020

· Reviewed medical records for accuracy, completeness, and regulatory compliance while maintaining HIPAA regulations.

· Updated understanding of insurance plans, associated claims documents, and maximum coverage amounts for procedures.

· Organized hard copies of medical records to increase record search efficiency.

· Entered medical paperwork into electronic health records efficiently and accurately.

· Processed admission and discharge documents quickly and accurately.

· Performed extensive research to process or adjust healthcare claims and appeals.

· Followed through with processes such as medical examinations and the completion of all forms to process new policies.

· Installed bookkeeping systems and resolved system problems.

· Promoted plans by skillfully explaining features and advantages and turning objections around to complete sales.

· Contacted underwriter and submitted forms to obtain binder coverage.

· Calculated premiums and establish payment method.

· Inspected property to determine its general condition, age, and other factors affecting the potential insurance risks.

· The collected information from clients about financial resources and needs to better understand their situations and select the best products.

· Monitored insurance claims to ensure equitable settlements.

· Maintained a well-organized and efficient medical records system, quickly filing and retrieving files for clinical team members.

Patient Registration Rep./Insurance Verification Specialist (LOP) Scripps Mercy Hospital - San Diego, CA

March 2007 to April 2009

• Verified health insurance information to check enrollment, eligibility, and insurance data integrity.

• I register patience, check-in, and check out

• Collected copay, deductibles

• Devised workflows to provide clear onboarding instructions and procedures.

• Developed indicators to monitor and evaluate the work quality.

• I analyzed verification processes to detect and curb fraudulent submissions.

• Scanned and indexed face sheets, progress notes, and insurance verification forms to update medical information.

• Maintained detailed knowledge of insurance coding information to accelerate the processing of patient claims.

• Created and maintained patient accounts to track contributions and expenditures.

• We investigated and resolved complaints and appeals relating to errors in claim processing for completed services.

• Prepared for the next day s patients by pulling charts and making confirmation calls.

• Scheduled and managed appointments and reduced no-shows by proactively confirming appointments.

• Prepared office daily schedules in line with staff availability and optimal patient loads.

• Maintained compliance with established policies, procedures, regulatory and accreditation requirements, and applicable professional standards.

• Moved patients through the registration process and prepared for clinical staff to maximize patient flow.

• Safeguarded confidentiality of patient information by consistently following patient protection standards.

• Answered phone calls throughout the day to provide information, set appointments, and take messages.

• Interacted with insurers to verify coverage and collect payments.

• Admitted patients, recorded assigned rooms, and printed patient labels on admission to the hospital.

• Kept medical records and correspondence current and accurate to maintain smooth operations.

• Scheduled and confirmed patients for diagnostic appointments, consultations, and procedures.

• Handled credits and collections, prepared and sent financial statements or bills, and kept financial records.

• Delivered excellent customer service and facilitated the development of patient and clinician relationships.

• Triaged and routed phone calls, took messages, and followed up to verify receipt of critical information.

• Facilitated flow of communication and information to all members of the department.

• Verified patient demographic data, forms, and insurance information.

• I completed and processed insurance documentation and other claim forms.

• Reviewed patient charts for completeness and accuracy and verified missing information. Medical Insurance Specialist

SHARPS MEMORIAL HOSPITAL - San Diego, CA

August 2004 to September 2007

• Followed up on claims submitted to insurance companies to mediate disputes and obtain reimbursement for services rendered during patient's treatment.

• Verified coverage with insurers, filed required forms, and submitted paperwork to obtain timely payments.

• Worked with medical coder to review clinical statements and assigned standard codes using CPT, ICD-10-CM, or HCPCS Level II system,

• Assembled data concerning patient's bills, including hospital stay, consulted doctor, processed payments, and insurance billing information.

• Collected required information from medical units to prepare bills.

• Answered questions from patients regarding billing charges by explaining services and clinical duties performed.

• Completed bills by collecting clinical and laboratory testing information for inclusion.

• Translated health care services into coded medical claims for submittal to insurers.

• Explained charges to patients and collect payments.

• Validated customer sales orders and create associated invoices.

• Reviewed documents such as purchase orders and sales tickets to calculate the charges due.

• Followed up on payment lapses.

• Organized a consistent schedule to stay on top of billing tasks and avoid payment delays.

• Reviewed and evaluated internal controls and supporting documentation.

• Processed load paperwork received via email and physical mail.

• Quickly processed incoming payments and posted them to the correct account.

• Tracked customer records and accounts within computerized accounting systems.

• Monitored payments.

• Verified and input billing charges into applicable systems.

• Handled timely coding keying of payroll and company invoices. Medical Billing Specialist

Healthcare Management Partnership - Mirmar, Ca

May 1998 to July 2004

· Verified coverage with insurers, filed required forms, and submitted paperwork to obtain timely payments.

· Assembled data concerning patient's bill, including hospital stay, consulted doctor, processed payments, and insurance billing information.

· Resolved questions related to charges.

· Handled timely coding keying of payroll and company invoices.

· Followed up on payment lapses.

· Translated health care services into coded medical claims for submittal to insurers.

· Reviewed statement setup requests for accuracy and appropriateness based on supporting documentation and applicable business rules.

· Inspected accounting records on monthly basis to identify and resolve discrepancies.

· Reviewed daily invoices.

· Discussed inquiries with customers to address questions about rates and procedures.

· Maintained relationships and communicating with key client personnel to understand business operations, processes, and functions

· Investigated product concerns and communicated with departments to understand customer issues.

· Kept records of customer interactions and transactions and recorded details of inquiries, complaints, and actions taken.

· Completed calls and followed scripts to maintain good call control.

· Engaged with customers to understand and resolve issues and answer product questions.

· Determined charges for services requested, collected deposits or payments, and arranged for billing.

· Referred unresolved customer grievances to designated departments for further investigation.

· Prepared and processed forms to change customer service levels.

· Updated customer accounts with current personal and purchasing information.

· Met and exceeded daily service quality and performance goals.

· Reviewed activities regularly to identify opportunities for improvement.

· Verified and reviewed data on insurance applications and policies such as age, name, principal sum, and address.

· Carefully checked and verified personal data, policy information and property values for each insurance application.

· Managed the efficient processing and documentation of new insurance policies and customer claims.

· Organized the insurance claims forms and related documents, checking each closely for completeness. Education

Medical Insurance Biller

Remington College - Colorado Springs, CO

March 2017

Associate of Science in Medical Insurance Biller and Coder College America - Colorado Springs, CO

April 2009 to July 2016

Certification in Health Services Administration

Heald College-Concord

February 1985 to June 1991

Skills

• Global logistics

• Training and leadership

• Performance management

• Client relations

• Vendor onboarding

• Inventory management

• Communication

• Quality control analysis

• Process optimization

• Customer service

• Efficiency improvement

• Shipping procedures

• Serve customers

• Oversee supply chain

• Source materials

• Train staff

• Invoice processing

• Data entry

• Insurance billing

• HIPAA compliance

• Payment processing

• Access software

• Verify data

• Review documents

• Collections processing

• Accounting and financial management

• Relationship building

• Records research

• Administrative support

• Payment collection

• Maintain records

• Paperwork and documentation

• Billing process management

• Correct errors

• Financial data entry

• Process payments

• Prepare statements

• Regulatory compliance

• Task prioritization

• Teamwork

• Customer relations

• Motivation

• ICD Codes

• Customer Service

• Fee Billing

• Cross-promote products

• Sell policies

• Update records

• Analytical thinking

• ICD-9

• Insurance Verification

• Medical Records

• ICD-10

• CPT Coding

• EMR Systems

• Medical Coding

• Financial Statement Preparation

Assessments

Call center customer service — Proficient

June 2021

Demonstrating customer service skills in a call center setting Full results: Proficient

Customer focus & orientation — Proficient

January 2021

Responding to customer situations with sensitivity Full results: Proficient

Recruiting — Proficient

September 2021

Managing the candidate sourcing and selection process Full results: Proficient

Typing — Completed

August 2022

Transcribing text

Full results: Completed

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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