ANISSA RAMOS
Victoria,TX
Overview
6
6
years of professional experience
Work History
Grievance Appeals Specialist
Humana
05.2023 - Current
- Provided training and mentorship to new team members, fostering a collaborative work environment focused on continuous improvement.
- Resolved escalated cases promptly and effectively, demonstrating strong skills when working the cases.
- Promoted a culture of continuous learning and development within the Grievance Appeals team, encouraging skill growth and knowledge sharing.
- Displayed excellent time management skills while managing multiple high-priority cases concurrently without compromising quality or attention to detail.
- Worked denied claims and sent them to the Medical Director so they can review and decision the case.
- Got moved from the post (claims) team to the Standard Pre service team. There i worked denied authorizations, strictly authorizations.
- Demonstrated exceptional problem-solving skills when faced with unique or challenging cases, resulting in successful resolutions that satisfied all parties involved.
- Organized regular meetings for the Grievance Appeals team to discuss updates, share knowledge, and address challenges collectively.
- Acted as a departmental resource on appeals matters.
- Looked up plenty of Evidence of Coverage polices to see if the requested services were within the members policy
Optometry Tech, Biller and Coder
Epic Vision Center
08.2020 - 05.2023
- Responsible for identifying medical coding procedures or fee errors and omissions, making necessary adjustments to patient accounts
- Provides insurance companies with the necessary documentation or records
- Collects, posts and manages patient account payments
- Submits claims to insurance companies
- Utilize the following databases for day-to-day functions: MDI, Nextech, and Crystal
- Schedule patients for eye exams
- Administer patient pre-eye exams, including visual field testing, AR reading, Retinal Imaging and vitals.
Child Care Provider
Kinder Care
01.2020 - 08.2020
- Cared for toddlers ages 9 months - 1 year
- Helped children with personal hygiene
- Maintained cleanliness in activity areas
- Planned activities for children
- Administered age-appropriate learning activities
- Prepared meals, supervised during nap time, and performed regular head counts.
Child Care Provider
Bright Ideas Enrichment Center
08.2019 - 01.2020
- Cared for toddlers ages 9 months- 1 year
- Prepared and organized meal times for children
- Attended to children's needs while helping to foster early development
- Planned and implemented early learning educational programs
Education
Exercise Science
Schreiner University
05.2018
Exercise Science
Costal Bend College
05.2015
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Alice High School
Alice, Texas05.2014
Skills
- Crystal Scheduling Software
- Detail Oriented
- MDI Software
- Medical Billing
- Medical Coding
- Multitasking
- Nextech Software
- Organization
- Patient interaction
- Case analysis
- Workflow management
Timeline
Grievance Appeals Specialist
Humana
05.2023 - Current
Optometry Tech, Biller and Coder
Epic Vision Center
08.2020 - 05.2023
Child Care Provider
Kinder Care
01.2020 - 08.2020
Child Care Provider
Bright Ideas Enrichment Center
08.2019 - 01.2020
Exercise Science
Costal Bend College
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Alice High School
Exercise Science
Schreiner University
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