Rosanna Espinosa

** *** ***** ******, ********, New Jersey 07008

201-***-****

ka7m5s@r.postjobfree.com

SUPERVISOR

QUALIFICATIONS PROFILE

Visionary, innovative and performance-driven professional offering 15 years of progressive career in assuming various management and supervision roles. Demonstrated record of success in analyzing viability of business ideas, developing creative strategies to meet goals and ability in executing processes that significantly generate positive results on time, under budget, and beyond expectations. Recognized leader who is adept at setting goals, coordinating, developing and managing operations for clinical, financial/accounting, administrative, IT and HR activities.

- Known for excellent talent in leveraging efficiency, management and quality processes.

- Proven effective thinker; accustomed to fostering positive working environment and openly embraces diverse backgrounds and experiences.

- Proficient in using Microsoft Suite, WordPerfect, Call Tracking, Comtron System, Amisys System, iCare/ iView, ProClaim, QuickBooks Pro / Peachtree, Benefits Access, ICMS System, Power MHS, CIRF, ICD-CM/CPT Coding, and various medical office procedures.

- Bilingual in Spanish and English languages.

CORE COMPETENCIES :

- Business Development

- Organization/Multi-Project Management

- Persuasive Communicator

- Organization needs assessment/analysis

- Strategic and tactical planning

- HRIS technology

- Human Resource Systems Alignment

- Training/Development

- Performance Assessment

- Project Management

- Business and Account Development

- Compensation/Benefits

- Strategic / Financial Planning

- Customer needs assessment

SUMMARY OF EXPERIENCE

LEADERSHIP AND SUPERVISION

- Conducted effective customer service leadership programs through managing the Shipping Department and all the data entry processes.

- Managed the practitioners and vendor’s contract data entry into all CIGNA transactional platforms.

- Streamlined prior authorization process by handling all inbound phone calls.

- Sorted cases for approval, procedure status that needs prior authorization and performed case referral for clinical follow-up.

- Ensured the compliance of referrals medical authorization with the CIGNA HealthCare policies, procedures, documentation and requirements.

- Led the preparation of accounts payable and receivables for all locations.

- Supervised all reports and provided assistance to managers in performing various departmental functions

- Directed the provider’s claim submission and contracts review.

HUMAN RESOURCES

- Performed human resources functions, which include handling accounts payables/ receivables and department collections.

- Mentored providers on health plan products and facilitated application process for providers.

- Performed document verification for accurate insurance payments.

- Conducted cash reconciliation, credit and insurance payments.

- Handled the entire past due accounts and sustained all reports.

- Rendered training to newly hired employees.

COLLABORATION AND CUSTOMER RELATIONS

- Negotiated with matrix partners in regard to practitioner and vendor’s demographic and reimbursement set-up.

- Established and sustained harmonious business relationships with physician, providers and practice manager.

- Provided superior quality service to clients through continuous communication with provider on the company’s policies and procedures.

PROCESS CONCEPTUALIZATION AND IMPLEMENTATION

- Efficiently addressed complaint and issues that arose in each account to maintain the department’s positive workflow.

- Ensured and emphasized physician’s data’ quality, accuracy and efficiency within a complex database.

- Served as primary point of contract in claim research issue resolution.

- Efficiently resolved provider’s complaints and disputes; ascertained the adherence of all services with the company’s policies and procedures.

EMPLOYMENT HISTORY

KAPITAL FREIGHT SOLUTION INC. ~ Avenel, NJ ~ 2006-2010

SUPERVISOR

VIP OPTICAL LAB / PARTNERS IN VISION ~ Linden, NJ ~ 2005-2006

CUSTOMER SERVICE MANAGER

CIGNA HEALTHCARE ~ New Jersey, NJ ~ 2002-2005

PROVIDER DATA MANAGEMENT SENIOR ASSOCIATE - PENDED CLAIM UNIT

PROVIDER RELATIONS SENIOR ASSOCIATE – 16 States

STATE EXPERT (Ohio Network – 4 States)

HEALTH SERVICE SPECIALIST (3 States)

ADVANCED VISION CARE ~ North Bergen, Vernon, NJ ~ 1997-2001

OFFICE MANAGER (2 Sites)

ATLANTIC PACIFIC TEA COMPANY ~ New Jersey City, NJ ~ 1995-1997

FRONT–END SUPERVISOR

EDUCATION

DIPLOMA IN BUSINESS ADMINISTRATION AND COMPUTERIZED ACCOUNTING ~ 2002

HoHoKus Hackensack, School of Business and Medical Sciences (Formerly American Business Academy) ~ Hackensack, NJ

MEDICAL CLERICAL ASSISTANT CERTIFICATE ~ 1997

The Cittone Institute ~ New Jersey City

ACHIEVEMENTS

- Received, Certificate of Achievement ~ Health Services, Department of Recognition, 2003

- Received, Certificate of Achievement ~ Provider Resolution, Department of Recognition, 2004

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