Summary
Overview
Work History
Education
Skills
Timeline
Generic

Ardeliah Vega

Las Vegas

Summary

Dedicated and highly motivated professional committed to leveraging a diverse skill set to enhance business performance. Exhibits strong adaptability in both individual and collaborative environments, driving company objectives forward. Resourcefulness and a results-driven mindset fuel a passion for growth and efficiency, ensuring alignment with organizational goals and increasing service value. Proven track record of delivering impactful contributions that support overall success and sustainability.

Overview

11
11
years of professional experience

Work History

Medical Billing Associate

Nasri PLLC
07.2025 - Current
  • Facilitated clear communication between medical staff and insurance companies, improving understanding of coverage limitations and reducing claim rejections.
  • Contributed to team success by actively participating in brainstorming sessions aimed at identifying areas for improvement within the billing department processes.
  • Developed comprehensive knowledge of various payer requirements for successful claim submission, minimizing delays in reimbursement.
  • Reduced claim denials by consistently verifying insurance eligibility prior to submitting claims for payment.
  • Assisted patients in understanding their financial responsibilities, explaining complex medical bills in an accessible manner.
  • Enhanced revenue recovery through diligent follow-up on denied or underpaid claims.
  • Prepared billing statements for patients and verified correct diagnostic coding.
  • Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
  • Reconciled accounts receivable to general ledger.

Appeals and Grievances Associate

Elevance
07.2024 - 06.2025
  • Logged and tracked verbal and written member grievances and appeals.
  • Conducted relevant research into complaints and collaborated, coordinated, and communicated with various departments (i.e. Member Services, Care Management, Claims), as well as external entities (i.e. Providers and Vendors) to collect additional information as necessary.
  • Maintained a current knowledge of plan products, policies and procedures and related acquired knowledge in a clear, concise and understandable manner to members, providers, and internal staff.
  • Ensured grievances and appeals are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy.
  • Prepared, generated, and mailed letters, forms, and other G&A-related notices.
  • Maintained confidentiality of all protected health information in accordance with state, federal, and corporate guidelines.

Pharmacy Associate

Capsule Pharmacy
02.2019 - 04.2024
  • Handle inbound/outbound communications across phone, text, chat, and E-mail
  • Answer questions, solve issues related to sales, insurance coverage, prescription status, and service inquiries from doctors, patients, insurance companies, and associates
  • Assist patients in understanding their insurance benefits, claims, and medications
  • Skilled in de-escalating and resolving critical feedback
  • Assist in leading and developing associates.
  • Facilitated communication between healthcare providers, pharmacies and insurance companies.
  • Performed detailed data entry into electronic medical records systems regarding patient prescription information.
  • Processed insurance claims quickly and accurately while ensuring compliance with all relevant policies.
  • Ensured that all health information was kept secure in accordance with HIPAA standards.
  • Developed strong organizational skills in order to manage multiple tasks, prioritize workloads and meet deadlines.
  • Contacted insurance companies to resolve billing issues.

Utilization Review/Compliance Specialist

MAS (Medical answering services LLC)
04.2016 - 05.2018
  • Worked directly with Head Nurse, reviewed DOH Medicaid 2015 and 2020 forms
  • Contacted Enrollees and medical providers
  • Researched CMMA physician availability, assisted in fair hearing processes, trip, and form concerns
  • Assisted call center with Inbound/outbound calls resolving customer needs and coordinating medical transportation
  • Evaluated medical documents and benefit coverage to determine the appropriateness of services
  • Performed prior authorization review of services requiring notification.

Utilization Review/Compliance Specialist

LogistiCare Solutions, LLC
10.2014 - 04.2016
  • Worked directly with Head Nurse, reviewed DOH Medicaid 2015 and 2020 forms
  • Contacted Enrollees and medical providers
  • Researched CMMA physician availability, assisted in fair hearing processes, trip, and form concerns
  • Assisted call center with Inbound/outbound calls resolving customer needs and coordinating medical transportation
  • Evaluated medical documents and benefit coverage to determine the appropriateness of services
  • Performed prior authorization review of services requiring notification.

Education

HS Diploma -

Liberty
06.2007

Skills

  • Understanding of medication classifications
  • Billing process management
  • Effective communication
  • Detail-oriented approach
  • Effective mediation techniques
  • CPT coding
  • Denial management techniques
  • Multichannel customer support

Timeline

Medical Billing Associate

Nasri PLLC
07.2025 - Current

Appeals and Grievances Associate

Elevance
07.2024 - 06.2025

Pharmacy Associate

Capsule Pharmacy
02.2019 - 04.2024

Utilization Review/Compliance Specialist

MAS (Medical answering services LLC)
04.2016 - 05.2018

Utilization Review/Compliance Specialist

LogistiCare Solutions, LLC
10.2014 - 04.2016

HS Diploma -

Liberty

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