Medical Billing Call Center

Rochelle L. De Jesus

*** ***** **, *********, ** 18015

484-***-**** • ****************@*****.***

Professional Summary

Detail-oriented healthcare professional with over 20 years of experience as a Medical Assistant, including 4 years of Leadership Experience, 10 years of experience in medical Billing and Collections, and 6 years of Call Center Representative experience in a high-volume center. Proven track record in managing transitions of care, leading teams, and ensuring efficient claims processing. Adept in both remote and on-site settings, with deep expertise in medical terminology, EHR systems, and patient/provider relations. Seeking opportunities as a Member Services, Customer Service, Medical Billing & Collections Specialist, or Patient Care Assistant

Core Competencies

Experienced in Utilization Review

Full Revenue Medical Billing, Claims Processing & Collections

Experienced in Medicare, Medicaid, Commercial Insurance Policies & Workman’s Comp

Benefits & Eligibility, Appeals & Grievances

Patient Care & Direct Clinical Support

Team Leadership & trains new hires

EHR Systems: EPIC, eClinicalWorks, Citrix

Microsoft Office: Word, Excel, Outlook

Customer Service & Member Advocacy

Phlebotomy, EKG, Glucometry, Vitals

Supply Inventory & Equipment Maintenance

Certifications

Basic Life Support (BLS) – Active

Professional Experience

Devoted Health – Remote

Clinical Coordinator

Jan 2022 – July 2025

Train New hires

Attach the clinical from EHR for chart review by nursing staff or Fax a request for information from providers and facilities

Make outbound calls to engage providers to verify clinical information, including Admissions & Discharge dates and status for Post Acute and Acute stays

Support operational tasks: managing fax queues, referral assignments, and EHR chart reviews.

Collaborate with Multiple roles & Departments, providers, and team members for a better member experience

Assist with reviewing and making changes to training SOP documents (Standard Operating Procedure)

St. Luke’s University Health Network – Bethlehem, PA

Patient Care Assistant (Part-Time)

Nov 2024 – Present

Perform vital signs, EKGs, glucometry, and assist with phlebotomy.

Support patient comfort, safety, and mobilization using proper techniques.

Document care activities and report patient condition changes to clinical staff.

Maintain unit equipment, supply, and support new staff orientation.

Assist in orienting and educating new staff

KelseyCare Advantage – Pearland, TX

Member Service Representative II – KSPA

Nov 2018 – Jan 2022

Call Center experience. Provided Member Service concierge service for members and providers to include claim status and resolutions.

Assisted with grievances, appeals, enrollment, and pharmacy-related Part D questions and concerns.

Assist with Organizational Coverage Determination

Assist with enrollment and Disenrollment inquiries

Assist with Prescription drug inquiries

Kelsey-Seybold Clinic – Pearland, TX

Customer Service Representative-Promoted within to Member Services Dept

Apr 2018 – Nov 2018

High volume call center experience. Verified insurance, updated patient demographics, and managed patient balances.

Supported clinic operations and patients.

Collected outstanding balances

Viewed claims for accuracy for both providers and patients

Principal Health Systems / Elemental Billing – Houston, TX

Team Lead – Billing & Collections

Dec 2016 – Apr 2018

Led a team of 6 handling high-volume toxicology and pathology billing across 4 hospitals in high call volume call center

Processed claims for third-party and commercial carriers, managed AR, handled denials, and coordinated appeals.

Uploaded new procedure codes and managed billing system updates.

Generated monthly statements for outstanding balance and mailed them to the patients

Worked on clearing house rejections, denied claims, appeals, and reconsiderations.

Uploaded Procedure codes and Pricing for New facilities

Ran weekly reports and Productivity Reports

Texas Gulf Coast Medical Group – Webster, TX

Medical Billing & Collections Specialist

Oct 2013 – Dec 2016

Managed full-cycle billing for PCP, dermatology, sleep studies, and workers’ comp.

Submitted claims to Medicaid (via THMP), third-party payers, and commercial insurers.

Oversaw AR, appeals, denials, reconsiderations, and collections on patient accounts.

Posted zero pay EOB’s

Verified Benefits and Eligibility

Schedule appointments for patients

Uploaded Medicaid claims into THMP

Education

Diploma – Medical Assistant

Berdan Institute 1999

Diploma

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