Cathlyn Baptiste
Fontana,CA
Summary
I'm diligent and experienced Benefits Reimbursement Specialist with five years of proven expertise in navigating complex reimbursement processes, who is seeking to leverage comprehensive knowledge and skills in a dynamic organization. Eager to contribute advanced proficiency in analyzing, verifying, and processing benefit claims with meticulous attention to detail and accuracy. Dedicated to ensuring timely reimbursement for clients while maintaining compliance with regulatory guidelines and company policies. Proficient at effectively communicating with stakeholders to resolve inquiries and discrepancies, fostering positive relationships. Ready to apply a track record of optimizing reimbursement procedures and driving efficiency to support organizational objectives.
Overview
11
11
years of professional experience
Work History
Intake Coordinator
Brothers Healthcare
10.2019 - Current
- Primary contact for initial administration of intake, insurance verification and authorization process
- Ensuring compliance to guidelines and department policy and procedures
- Manages day-to-day operational functions of intake, insurance verification and authorization teams to include work flow management, inventory management, system updates, reporting and training
- Interprets policies and procedures, guidelines, regulatory requirements, health plan requirement, contractual agreements and other related documentation in order to assist staff with claims questions
- Responsible for creating, assigning, maintaining and communicating standard work to staff in a timely and consistent manner as well as creating monthly schedules for respective teams
- Understands third party reimbursement guidelines and methodologies as it relates to revenue generating opportunities
- Streamlined intake process by implementing efficient data collection and organization methods.
- Maintained strict confidentiality of patient information, adhering to HIPAA guidelines and company policies.
- Collaborated with healthcare professionals to ensure patients received appropriate services and resources.
Reimbursement Specialist
Option Care
04.2018 - 10.2019
- Home Infusion Therapy Claim Billing and Collecting
- NCPDP Pharmacy claim Billing and Collecting
- Working knowledge of healthcare insurance practices
- Knowledge of healthcare payer/insurance types: Commercial, Medicare, Medicaid, CCS, Patient Pay
- Achieve productivity goals
- Communicate effectively with team/management regarding payer/ patient account issues
- Knowledge of Pharmacy, Medical Terminology and International Classification of Disease (ICD-10) and Current Procedure Terminology (CPT)
- Use of CPR+ Pharma Point Software- Account Management: Obtain Prior Authorizations for services; run eligibility for accurate insurance coverage; create, edit and submit claims; Problem solve and initiate steps to get claims paid/resolved (Appeal Process, Make contact with payer); clean up accounts with bad debt, contractual adjustments or refunds.
Reimbursement Analyst
Prime Healthcare
06.2017 - 04.2018
- Working knowledge of healthcare insurance practices
- Knowledge of healthcare payer/insurance types: Commercial, Medicare, Medicaid
- Claim pricing according to contractual agreements with Prime Healthcare (Medical/Medicaid, Medicare, Commercial plans)
- Account Management: run eligibility for accurate insurance coverage; create, edit and submit claims; Problem solve and initiate steps to get claims paid/resolved (Appeal Process, Make contact with payer); clean up accounts with adjustments in accordance to facility contract and Patient Responsibility
- Facility leader of Landmark Medical Center in Rhode Island
- Knowledge of Medical Terminology
- Use of Epic & Medi Tech software
Front Desk Supervisor
Country Inn & Suites
05.2016 - 06.2017
- Customer Service: Make/edit/cancel reservations; Problem solve to each individual guest's needs/concerns; maintain a welcoming environment for all guests
- Assist sales manager in large room bookings and accommodations
- Assist General Manager with creating reports: Room accommodations, complete payments, and cash balancing sheets
- Communicate with Laundry & maintenance staff to have updated room status on availability and readiness
- Prepare meeting rooms in various set ups
- Manage, train, schedule, and support all front desk employees
- Detailed room inspections to maintain safety and cleanliness standards
Sales Associate/ Key-holder
Charlotte Russe
10.2013 - 05.2017
- Customer service: retrieve correct shoe sizes; ensure all sizes of cloths are out for each customer to have; greet and assist customers with questions on sizes, or online lookups; maintain a fun, welcoming environment for customers to shop
- Style expert; assist customers in finding select clothes, shoes and accessories that is customized to the customers style and personality
- Manage employees per shift: maintain coverage in fitting rooms & cash register; support team with help in all departments
- Open/close store: balance all cash registers according to the cash intake report; balance the safe ensure my team perform morning/nightly cleaning duties
- Cash handling
Education
Associate of Arts - Social And Behavioral Studies
Norco College
Norco, CA05.2023
Associate of Science - Administration of Justice
Norco College
Norco, CA05.2023
High School Diploma -
Eleanor Roosevelt High School
Eastvale, Ca06.2012
Skills
- Insurance Verification
- Report Preparation
- Data Entry
- Project Management
- Workflow Optimization
- Documentation and Recordkeeping
- Medical Billing
- Analytical Thinking
- Multi-Line Phone Systems
- Customer Service Management
- Follow-up skills
- Inventory Management
Timeline
Intake Coordinator
Brothers Healthcare
10.2019 - Current
Reimbursement Specialist
Option Care
04.2018 - 10.2019
Reimbursement Analyst
Prime Healthcare
06.2017 - 04.2018
Front Desk Supervisor
Country Inn & Suites
05.2016 - 06.2017
Sales Associate/ Key-holder
Charlotte Russe
10.2013 - 05.2017
Associate of Arts - Social And Behavioral Studies
Norco College
Associate of Science - Administration of Justice
Norco College
High School Diploma -
Eleanor Roosevelt High School
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