Summary
Overview
Work History
Education
Skills
Job
Timeline
Generic

April Baez

Davie,FL

Summary

Experienced clerical professional seeking growth opportunities with a company. Skilled in clerical support and claims specialist roles, excelling in fast-paced environments with high caseloads. Organized, driven, and adaptable with strong planning and problem-solving abilities. 25 Years of experience, ready to tackle any challenge. Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Overview

22
22
years of professional experience

Work History

Remote Disability Claims Specialist/Benefits Service Representative

NEBA
09.2020 - 05.2025
  • Company Overview: Remote Disability Claims Specialist/Benefits Service Representative-NEBA is a full service Third-Party-Administrator (TPA) that specializes in administration of Taft-Hartley benefit plans.
  • Some of my job duties include but not limited to: answering phone calls and emails, responding to customer questions and complaints, and walking customers through basic troubleshooting or setup processes. Responsible for maintaining up to date patient account records; Respond to provider and patient inquiries, whether verbal or written. I was promoted to Short Term Disability and Medical Claims Specialist/Case Manager in 2023. I handled the process for our union members who had applied for Short Term Disability Benefits. Duties: Managed assigned caseload of Short-Term Disability claims. Review disability documentation and determine whether to pend, deny or pay claims, in put data. Evaluates claimant eligibility via information received from claimant, treating physician and employer. Decided payment period, follow ups, monitored payment accuracy and timeliness. Followed and established claim policies and practices to resolve claims and issues. Reviewed initial and reconsideration claims and applications as well as continuing Disability review of claims. Requested information and contacted applicant, physician and employer via phone, email, mail and fax. maintain and review case files, provide support and assistance to the applicants. Helped the applicants to navigate the application process and answer their questions. Self-Insured Claims Administration
  • Medical
  • Dental
  • Vision
  • Death Benefits
  • AD & D Benefits
  • Short Term Disability Benefits
  • Appeals Administration

Intake Coordinator/Appeals Specialist

Lifesure LLC
01.2018 - 05.2020
  • Company Overview: Lifesure Home AED Solutions is a home medical equipment company that exclusively specializes in the delivery of Home AEDs to patients (mostly pediatric) at high risk of life-threatening cardiac arrhythmias.
  • Some of my job duties include but not limited to: Managing the registration process of patients or clients into Futura database that cardiologist and electro-physiologist office would refer to the company via fax or secure email; Gathered patient records, taking medical histories, and obtaining any insurance information from the medical office and or patient’s family; Worked directly with insurances to gain coverage for each device, authorizations, gap exceptions aka PPO waiver and single case agreements; Responsible for maintaining up to date patient account records; Respond to insurance and patient inquiries, whether verbal or written. Worked as the managers assistant for all miscellaneous duties such as supply ordering, office equipment setup/maintenance, report creation/maintaining.
  • Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
  • Enhanced communication between interdisciplinary teams, ensuring patient needs were met comprehensively and efficiently.

Medpro Billing Specialist

Medpro
09.2016 - 12.2017
  • Company Overview: Medpro is a nationwide medical billing and patient management service for the Mental Health and Substance Abuse community since 1992.
  • Some of my job duties include but not limited to: Downloading EFT’s from various insurance sites; Payment posting to various client’s accounts in the Edgemed database; Keeping a running spreadsheet of received posting, adjustments and posted checks; Report to facility, account managers with all posting reports.
  • Maintained detailed records of each account''s payment history, providing easy access to information for audit and analysis purposes.
  • Reduced errors in financial records by conducting regular audits of billed accounts.
  • Reduced billing errors, leading to decrease in customer complaints, by conducting regular audits of billing data.
  • Used data entry skills to accurately document and input statements.
  • Handled account payments and provided information regarding outstanding balances.

Office Coordinator

Tenet FL Physician Services-Robert Cywes
07.2015 - 08.2016
  • Company Overview: General Surgery, Bariatric and Pediatric Surgeon office.
  • Some of my duties include but not limited to: Answering phones; Scheduling appointments in Nextgen and Athena; Insurance verification in Ability; Greeting patients; Collecting co-pays; Charge posting; Running daily reports and reconciliation reports; Bank deposits; Scheduling surgery; Submitting authorization request to insurance; Scanning notes into EHR; Office supply ordering; miscellaneous clerical duties assigned by physician.

Office Manager

Genesis Home Health Care
03.2014 - 07.2015
  • Company Overview: A full-service healthcare organization: Medicare/Managed Care and private home health care services.
  • Some of my job duties include but not limited to: Answering phones; Data Entry in Kinnser database, and Care Centrix Portal; Payroll; Human Resources; Billing; Intake; Staffing; Scheduling; Filing; create and update forms in excel; sending, tracking and receiving of doctors’ orders; Oasis transmission to state; Posting payments to clients file; Creation of patient charts; after hours on call.

Case Management Coordinator

MCNA Dental
01.2013 - 01.2014
  • Company Overview: MCNA is a dental benefits administrator that provides service to state agencies and managed care organizations for Medicaid, CHIP, and Medicare members.
  • To coordinate dental case management activities related to dental services for special needs members. Some of my job duties include but not limited to: Ensure members are eligible with MCNA; Contact guardians by phone based on requests from various resources; Complete an initial assessment form with members requesting assistance or referred to case management; Provide information and answer questions to members about MCNA’s case management program; Provide appointment scheduling assistance for dental check-ups; Locate dental office that can meet member’s special needs; Contact dental offices to confirm attendance to appointments; Obtain treatment plans, x-rays, pre-authorization and referral requests or office notes as required; Maintain member’s comprehensive dental record; Document all contacts and attempted contacts in DentalTrac database; Enter complaints as directed.
  • Facilitated multidisciplinary team meetings, promoting open dialogue among various healthcare professionals involved in each patient''s case.

Data Entry/Staffing Coordinator

Firstat Nursing Services
10.2010 - 08.2012
  • Company Overview: A full-service healthcare organization: Medicare/Managed Care home health care, Facility Staffing and RN Care Management services.
  • Some of my job duties include but not limited to: Answering phones; Data Entry in Care Centrix Portal, Prime link, Haven, and HQS; Payroll; Clerical patient chart audits; Typing of patient Plan of Cares (POC’s); Creation of patient charts; Crossed trained in all the clerical job functions.

Office Manager/Clerical Support

HRC Home Health
02.2007 - 08.2010
  • Company Overview: A Medicare Certified home health agency serving all of Broward County.
  • Some of my job duties include but not limited to: Answering phones; Assistant Biller, Data Entry, Responsible for clerical and medical supply Inventory; Payroll; Clerical patient chart audits; Typing of patient Plan of Cares (POC’s); Creation of patient charts; Training new personnel; Crossed trained in all the clerical job functions.

Managed Care Coordinator

Absolute Home Health
08.2006 - 02.2007
  • Company Overview: A home health agency serving all of Broward, Palm Beach, and Dade County.
  • Contracted to accept Private pay, Medicare, Managed Care, Long term care, and Workmen’s compensation. Some of my job duties include but not limited to: Answering phones; data entry of patient information into an access data base called Visitrax; coordinating care for managed care patients; requesting and receiving authorization for follow up skilled visits on managed care patients; sending request for medical supplies to the supply company; verify all notes for payroll and billing purposes; run various reports for daily updates; daily contact with patients, Atenda (managed care company), and field personnel by phone and in person.

Staffing Coordinator

Amedisys Home Health
10.2005 - 08.2006
  • Company Overview: A Medicare home health agency serving all of Broward county.
  • Some of my job duties include but not limited to: Answering a 6-line switchboard; create and update forms in excel; distribution of mail to proper personnel; data entry; medical records upkeep; sending, tracking and receiving of doctors’ orders; staff the initial start of care and any other disciplines based on the patient's individual needs; scanning of an oasis into an HQS database; have contact with the patient and personnel by phone and in person on a daily basis; verify all notes for payroll and billing purposes; run various reports; chart audits to make sure frequency and orders are being followed.

Receptionist

Alliance Care formerly Care Givers/Care Advantage/MD to You
06.2003 - 10.2005
  • Company Overview: A Medicare home health agency along with a private aide division, physician’s that go to patients’ home, mobile ultrasound and x-ray technicians.
  • My duties included but not limited to: Answering a 10-line switchboard; create and update forms in excel; office supply ordering; ordering forms from the printer; tracking and matching invoices to purchase order for further approval; distribution of mail to the proper personnel; data entry; some Human Resource functions such as the application and interview process; orientation and helping with all the hire paperwork; maintenance and troubleshooting of all office equipment; helping all other departments when needed; medical records upkeep; sending, tracking, and receiving of physicians orders.
  • In September of 2004 I was promoted to Staffing Coordinator where I staff the initial start of care and any other disciplines based on the patient's individual needs; data enter all frequencies set by discipline into an Infosys data base; have daily contact with the patient and personnel by phone and in person on a daily basis; verify all notes for payroll and billing purposes; run various reports; chart audits to make sure the company is in compliance with the state.

Education

Some College (No Degree) - Health Care Administration

Keiser University
Fort Lauderdale, FL

Skills

  • Excellent interpersonal skills
  • Computer literate
  • Organizational growth
  • Claims processing proficiency
  • Self-motivation and initiative
  • Time management capabilities
  • Adaptability
  • Medical terminology
  • Problem-solving
  • Attention to detail
  • Organizational skills
  • Dispute resolution

Job

  • Organized
  • Team Player

Timeline

Remote Disability Claims Specialist/Benefits Service Representative

NEBA
09.2020 - 05.2025

Intake Coordinator/Appeals Specialist

Lifesure LLC
01.2018 - 05.2020

Medpro Billing Specialist

Medpro
09.2016 - 12.2017

Office Coordinator

Tenet FL Physician Services-Robert Cywes
07.2015 - 08.2016

Office Manager

Genesis Home Health Care
03.2014 - 07.2015

Case Management Coordinator

MCNA Dental
01.2013 - 01.2014

Data Entry/Staffing Coordinator

Firstat Nursing Services
10.2010 - 08.2012

Office Manager/Clerical Support

HRC Home Health
02.2007 - 08.2010

Managed Care Coordinator

Absolute Home Health
08.2006 - 02.2007

Staffing Coordinator

Amedisys Home Health
10.2005 - 08.2006

Receptionist

Alliance Care formerly Care Givers/Care Advantage/MD to You
06.2003 - 10.2005

Some College (No Degree) - Health Care Administration

Keiser University

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