Maria Ramirez
Sylmar,CA
Summary
To obtain a position where communication skills are utilized. To build a positive and productive work environment with team member. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Insurance Follow-up
Acclara Solutions
01.2019 - Current
- Denials adjustments/no response
- Work accounts to resolve payer rejections and denial
- Performs appropriate action to process accounts to resolution
- Insurance services follow-up
- Verifying DOFR
- Verifying benefit/coverage with the health plan
- Follow up on payer denials
- Obtain missing explanation of benefits from payers
- Coding review request
- Charge correction update
- Submit COB letter to patient.
- Streamlined follow-up processes for improved efficiency, ensuring timely resolution of unpaid claims.
Facey Medical Foundation Patient Accounts
Acclara Solutions
05.2016 - 01.2019
- Taking incoming calls from Patients/Health plans
- Processing patient payments
- Handling account escalated issues
- Working on credit balance report
- Working patient correspondence reports
- Verifying eligibility
- Verifying benefit/coverage with the health plan
- Working on return mail
- Offering financial assistance to patients
- Reviewing accounts for possible collections
- Patient reinstatements.
Regal Medical Group Member Service Representative
Regal Medical Group
03.2013 - 04.2016
- Answer general phone calls
- Authorization Status
- Authorization Redirect
- Claim Status
- Co-payment Verification
- File Grievances
- Verify eligibility and conduct urgent eligibility request
- Obtain POA’s
- Verify DOFR
- Employee eligibility and benefit verification
- Assist Member /Providers and Health Plans
- Check Tracers
- Update Member demographics
- Balance Billing issues
- Advising turnaround time for claims
- Mail out Authorizations to members
- Fax Authorizations to Providers/ Facilities
- Advising Auth turnaround time
- Assist members with billing issues.
One Call Medical Customer Care Coordinator and Service
One Call Medical
05.2011 - 08.2012
- Taking incoming/outgoing calls in a high volume call center environment
- Entered brand new medical referrals into the system
- Verify insurance, eligibility, authorizations
- Scheduled works compensation patients for MRI’s, CT scan, Ultrasound and EMG
- Made sure the procedure and diagnose match in the system
- Confirmed exam with the Referring Doctor and to obtain a copy of the Prescription
- Confirmed authorization with the main insurance company and nurse case manager
- Schedule appointments with providers in the patients area.
Education
San Fernando High School
01.1999
Skills
- Customer Service
- Computer savvy
- Medical terminology
- Microsoft word, Excel
- Able to multi-task
- Bilingual
Certification
Nursing Certificate, Concord Career College, 2002
Timeline
Insurance Follow-up
Acclara Solutions
01.2019 - Current
Facey Medical Foundation Patient Accounts
Acclara Solutions
05.2016 - 01.2019
Regal Medical Group Member Service Representative
Regal Medical Group
03.2013 - 04.2016
One Call Medical Customer Care Coordinator and Service
One Call Medical
05.2011 - 08.2012
San Fernando High School
Similar Profiles
Shaundra PeteShaundra Pete
Customer Service Representative at Acclara SolutionsCustomer Service Representative at Acclara Solutions
Davin MartinDavin Martin
Intern at Acclara SolutionsIntern at Acclara Solutions
Derius JacksonDerius Jackson
Operations Team Lead III at Acclara SolutionsOperations Team Lead III at Acclara Solutions
Tresa AmraniTresa Amrani
Process Improvement Manager at Acclara SolutionsProcess Improvement Manager at Acclara Solutions
Jenna AguilarJenna Aguilar
IHSS Care Provider at California Department of Social ServicesIHSS Care Provider at California Department of Social Services