Adianez Lugo
Lake Wales,FL
Summary
Results driven Denials Management Specialist with extensive experience in healthcare revenue cycle, claims appeals, and patient financial services. Consistently exceeds productivity targets and maintains a 100% accuracy rate on audits. Proven leader in both frontline operations and complex denial resolution, known for fast and effective problemsolving. Strategic Management Specialist known for high productivity and efficient task completion. Skilled in strategic planning, project management, and operational improvement. Excel at communication, leadership, and problem-solving to achieve goals and improve organizational performance. Committed to leveraging these skills to drive success and efficiency in challenging environments.
Overview
18
18
years of professional experience
Work History
Denials Management Specialist
AdventHealth
03.2022 - Current
- Successfully manage and resolve underpaid and denied claims, leading high-level appeals to secure proper reimbursement.
- Trusted to handle escalated case files and resolve complex provider issues with speed and precision.
- Regularly exceed productivity benchmarks, and maintain perfect audit scores.
- Entrusted with training new employees, providing guidance, and support to help them integrate smoothly into the team.
- Developed material to help with TPA websites and information for myself, and the team to use.
- Helped management with side projects to clean up aged accounts.
Patient Financial Services Rep/Collector
AdventHealth
06.2021 - 03.2022
- I was trusted to help any other department that was shorthanded due to my ability to learn each payor and their policies quickly.
- Managed the post-billing lifecycle, learning multiple insurance processes and ensuring accurate collections.
- Specialized in Medicare billing and consistently met all collection targets.
- Assisted team members in training on best practices for account management.
- Resolved discrepancies with insurance companies regarding claim payments.
Patient Financial Counselor
AdventHealth
06.2017 - 06.2021
- Educated patients on financial assistance programs and insurance options.
- Screened uninsured patients for Medicaid eligibility, completed applications, and secured coverage to ensure hospital payment.
- Helped non-insured patients apply for county-funded programs to help with their bills. Attended bi-monthly meetings in a smaller Florida county (Hardee) to bring the applications of non-insured patients and plead their case for assistance in paying their bills.
- In October 2022, I was able to convert $1.2M of self-pay claims to Medicaid-eligible claims.
- Collaborated with hospital staff members to resolve complex billing issues.
- Assisted patients in navigating state processes to apply for disability benefits through Social Security when diagnosed with a qualifying condition.
Shift Manager
Pizza Hut
02.2008 - 06.2021
- Oversaw daily operations, bank deposits and day-to-day work.
- Built a bi-weekly schedule based on the projected sales and made adjustments as needed.
- Ensured smooth business performance and provided excellent customer service.
- Managed inventory levels and placed orders to maintain stock availability.
- Trained new staff on customer service standards and operational procedures.
- Implemented health and safety protocols to ensure a safe working environment.
Education
Associates of Arts - Information Technology
University of Phoenix
GED -
South Florida State College
Skills
- Precision in results
- Critical thinking skills
- Training and Leadership
- Multitasking Abilities
- Excellent communication
Additional Work Experience
Upon Request.
Languages
Spanish
Full Professional
References
- Ira Arnan- Exec. Director of PFS Operations- AdventHealth P: 863.386.6362
- Crystal Sanchez- Mgr Reconciliation Services- AdventHealth P: 863.386.6378
Timeline
Denials Management Specialist
AdventHealth
03.2022 - Current
Patient Financial Services Rep/Collector
AdventHealth
06.2021 - 03.2022
Patient Financial Counselor
AdventHealth
06.2017 - 06.2021
Shift Manager
Pizza Hut
02.2008 - 06.2021
Associates of Arts - Information Technology
University of Phoenix
GED -
South Florida State College