Albert Alexander Tejada Grullón
The Bronx,NY
Summary
Resourceful Medical Billing Specialist known for high productivity and efficiency in task completion. Specialize in accurate claim submission, effective revenue cycle management, and comprehensive insurance follow-up. Excel in problem-solving, communication, and time management to ensure smooth financial operations within healthcare settings.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Process Developer
Ruby Staffing
04.2024 - 11.2024
- Created process documentation including flowcharts, SOPs, job aids and work instructions.
- Analyzed existing business processes to identify areas for improvement, and increased efficiency.
- Evaluated alternative methods for completing tasks within established deadlines.
- Ensured all processes were user-friendly, and efficient.
- Provided clarification on processes to team members as needed, and documented and maintained records of all process-related changes and updates.
Quality Analyst
Ruby Staffing
10.2023 - 04.2024
- Reviewed claims and actions taken to ensure they are accurate and compliant with the quality rules.
- Provided thorough documentation on all quality control activities and results.
- Ensured compliance with company standards, regulations and procedures related to quality control.
- Assisted in the development of Quality Assurance procedures and protocols.
- Maintained quality assurance procedure documentation.
Medical Billing Specialist
Ruby Staffing
01.2022 - 10.2023
- Researched complex billing issues involving multiple providers or services rendered over a period of time.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
- Updated patient accounts with information obtained from internal departments or external sources.
- Ensured HIPAA compliance by maintaining confidentiality of all patient information.
- Conducted research on insurance policies, procedures, and regulations to ensure compliance with all applicable laws.
- Verified the accuracy of claim data prior to submission to insurance carriers.
- Applied payments, adjustments, and denials into medical manager system.
- Collaborated closely with other departments to resolve claims issues.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Checked claims coding for accuracy with ICD-10 standards.
Customer Service Rep - chat
Teleperformance
10.2021 - 12.2021
- Answered customer inquiries and provided accurate information regarding products and services.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Gathered customer feedback through surveys and used the data to improve customer service.
- Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
- Tracked orders from start to finish to ensure timely delivery of goods or services.
Customer Service Rep
Teleperformance
03.2021 - 08.2021
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Tracked orders from start to finish to ensure timely delivery of goods or services.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Strengthened customer retention by offering discount options.
Education
High School Diploma -
Centro de Excelencia Prof. Liduvina Cornelio
01.2020
Advanced English Diploma -
Max teaching center
01.2019
Skills
- Modern humanities and languages
- Office
- Quality Auditing
- Problem-solving skills
- Multitasking skills
- Medical Billing Knowledge
- High level of accuracy
- Data Entry
- Time Management
- Analytical Skills
- Business Process Improvement
- Files and records management
- Insurance verification
- Payment posting
- Claim submission
- Customer service
- Best practices and methodologies
Languages
- Spanish, Native
- English, C1
Personal Information
Date of Birth: 08/12/02
Certification
- IT Essentials 7 - December 7th 2020
References
References available upon request.
Timeline
Process Developer
Ruby Staffing
04.2024 - 11.2024
Quality Analyst
Ruby Staffing
10.2023 - 04.2024
Medical Billing Specialist
Ruby Staffing
01.2022 - 10.2023
Customer Service Rep - chat
Teleperformance
10.2021 - 12.2021
Customer Service Rep
Teleperformance
03.2021 - 08.2021
High School Diploma -
Centro de Excelencia Prof. Liduvina Cornelio
Advanced English Diploma -
Max teaching center
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