ANA I. MARZO RODRIGUEZ
HOMESTEAD,USA
Summary
Experienced professional with extensive background in planning and executing events and initiatives to optimize organizational potential. Proven expertise in medical coding, billing, risk management, and regulatory compliance, with a strong track record of improving operational efficiency and resolving claim disputes. Exceptional leadership abilities complemented by bilingual communication skills (English/Spanish) enable effective client relations and team management. Committed to leveraging analytical insights to enhance service delivery and drive strategic growth.
Overview
9
9
years of professional experience
Work History
Chief Administrative Officer
Miracle Community Behavioral Center
Miami, Florida
01.2021 - Current
- Manage daily operations for a multi-specialty healthcare practice, including medical coding, billing, and banking functions
- Develop and manage compensation, benefits, and staffing, ensuring compliance with industry standards and regulatory requirements
- Oversee the recruitment, onboarding, and compliance training for new staff, including ensuring proper credentialing and prior authorizations
- Negotiate with insurance providers to resolve claim disputes and ensure contract compliance
- Conduct regular audits of patient records, billing submissions, and insurance claims to identify discrepancies and ensure accuracy
- Ensure all claims are processed in compliance with Medicare regulations and medical coding standards (CPT, ICD-10, DRG)
- Liaise with external vendors and insurance providers to resolve payment issues and manage risk mitigation processes
- Provide staff training in medical terminology, claims submission protocols, and best practices in claims management
- Analyze data to identify trends in claims denials and recommend process improvements to reduce errors and improve the timeliness of claims processing
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Prepared records for site visits and file audits.
- Conducted primary source verifications such as background checks and board certifications.
Quality Assurance Analyst
Miracle Community Behavioral Center
Miami, Florida
01.2019 - 01.2021
- Managed quality assurance audits for medical claims, ensuring compliance with healthcare regulations and industry standards
- Analyzed claims data to identify patterns in claim rejections and discrepancies, collaborating with the billing and coding teams to resolve issues
- Conducted risk assessments to identify and mitigate potential losses related to claims errors or mismanagement
- Provided ongoing training for team members on medical coding practices, regulatory changes, and claims auditing procedures
- Worked closely with insurance providers to negotiate claim adjustments and ensure timely processing of medical claims
- Developed detailed plans based on broad guidance and direction.
- Leveraged data and analytics to make informed decisions and drive business improvements.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Reviewed applications and other data sources for accuracy and completeness.
- Maintained strict confidentiality with regard to protected health information.
- Served as resource for physicians in credentialing and privileging process.
- Maintained current knowledge of medical staff bylaws, rules and regulations, policies and procedures and credentialing requirements.
- Initiated follow-up communications required to adequately research and secure information necessary to facilitate credentialing goals.
- Received and evaluated applications to look for missing and inaccurate information.
Patient Care Secretary
Vitas Healthcare
Miami, Florida
01.2018 - 01.2019
- Coordinated communication between patients, families, and medical professionals to streamline claims-related inquiries
- Ensured timely processing of billing documentation and communicate with insurance providers to facilitate claim submissions
- Assisted the billing department in managing insurance claim follow-ups and documentation
- Managed and updated patient records to ensure all necessary documentation was submitted for accurate claims processing
Direct Support Assistant
Miami Cerebral Palsy Residential Services
Miami, Florida
01.2016 - 01.2017
- Assisted in the coordination of patient care activities, supporting medical documentation for insurance and claims purposes
- Collaborated with healthcare teams to ensure that patient needs were met, supporting the timely and accurate processing of claims
Education
Bachelor of Business Administration -
Florida National University
Miami, FLBachelor of Science - Psychology
Florida National University
Miami, FLAssociate of Science -
Habana University
La Habana, CubaMaster Of Advanced Study - Mental Health Counseling
Barry University
Miami, FL 01.2025 - Current
Skills
- System backups
- Website maintenance
- Excellent English and Spanish communication skills
- Ability to handle stress effectively
- Excellent customer service skills
- Data management and organizational skills
- Oversight of Office Operations
- Relationship building
- Clerical training and experience
- Proficient in Written and Verbal Medical Communication
- Diagnostic and problem-solving skills
- Computer software proficiency
- Advanced emotional intelligence
- Proficient in Microsoft Office programs
- Proficient in Practice Fusion
- Proficient in Tanium
- Proficient in Athena Health
- Proficient in Lauris Online
- Good typing speed (60 words per minute)
- Quality assurance
- Adaptable and flexible
- Business intelligence
- Staff management
- Contract negotiation
- Analytical skills
- Client engagement
- Organizational leadership
- Regulatory compliance
- Operations management
- Client relationship management
- Multitasking Abilities
Accomplishments
- Successfully led to the implementation of an automated claims tracking system that reduced claim processing time by 20%.
- Spearheaded a claims audit process that identified and corrected discrepancies, resulting in a 15% reduction in claim denials.
- Played a key role in negotiating contract terms with insurance providers, improving claim resolution timelines by 25%.
- Trained a team of 10+ staff members on Medicare compliance and medical coding, increasing claims accuracy and reducing errors by 30%.
Timeline
Master Of Advanced Study - Mental Health Counseling
Barry University
01.2025 - Current
Chief Administrative Officer
Miracle Community Behavioral Center
01.2021 - Current
Quality Assurance Analyst
Miracle Community Behavioral Center
01.2019 - 01.2021
Patient Care Secretary
Vitas Healthcare
01.2018 - 01.2019
Direct Support Assistant
Miami Cerebral Palsy Residential Services
01.2016 - 01.2017
Bachelor of Business Administration -
Florida National University
Bachelor of Science - Psychology
Florida National University
Associate of Science -
Habana University
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