Billing Operations Specialist with Insurance Focus
Resume:
YOLANDA GREGO
Folsom, CA *****
**.*****@*******.***
linkedin.com/in/yolanda-grego-ab483598
BILLING OPERATIONS SPECIALIST
Experienced Billing Specialist with a demonstrated history of working in the insurance industry. Skilled in Sales, Management, Leadership, Marketing, and Data Analysis. Strong support professional with a desire to generate quality work.
Key Skills
Sales Business Analysis
Leadership Selling
Management Marketing
Data Analysis Organization & prioritization skills
EXPERIENCE
Health Net/ Centene,
Billing Operation Specialist, Membership & Accounting, August 2017 - Present
Processed incoming Softheon and OMNI PROD requests through work baskets.
Worked IFP and Reject Reports with 1 days turn-around time.
Responded to internal/external inquiries regarding enrollment..
Worked any and all special reports/assignments with efficiency.
Worked UMV and Filenet.
Worked member’s transaction requests in the customer management system
Generated and coordinated distribution of enrollment kits and identification cards.
Processed overage dependents.
Assisted members with navigation in the member public and secure sites.
Performed PCP auto assignments/ member outreach process.
Updated enrollment information, including demographic/ contact information.
Placed outbound calls to collect premium payments for pre-enrolled members.
Work ABS to reconcile Wells Fargo & Citibank payments through posting payments & creating & documenting spreadsheets
Work Pay/Ad WB for EMBARK system .
BAD DEBT
Queues in SFTN: Credit Memo, MISSING 834, FFM Refunds, OMNI HICS ESCULATION REFUND REVIEW, REVIEW FOR REFUND, PAYMENT HOLD for ENR, PRE EXPORT AUDIT high balance, FMS from ENR processing.
EMBARK Validation Project
Refund Database- MLR refunds & CA Refunds
Medical Documentation Reviewer (through Kelly Services), November 2014 – August 2017
Processed in coming medical documents for veterans in both PC3 and Choice.
Made out-bound calls to providers to gather necessary information to support incoming medical documentation.
Worked on special assignments when called upon and completed same day.
Made corrections to PC3 Edits, 1st, 3rd, Final Reminders and Pending Reminders.
Made corrections to 1-9 folder and work to resolve issues in the Claims box.
Worked any and all additional mandatory OT that is called upon.
Maintained an accuracy of performance of 98%.
Successfully fulfilled the 4 Pillars of the RAOC Program: Production, Quality, Overtime and Attendance.
Served as Auditor for new DOMA representatives in educating and training of processing medical documentations for HNFS.
EDUCATION
California State University, Sacramento
Bachelor of Arts (B.A.), Psychology
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