Australia Rodriguez

Work History

Claims Processor

Optum

10.2023 - Current

Managed workload and priorities to meet claims processing meet deadlines.
Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
Verified patient insurance coverage and benefits for medical claims.
Researched and resolved complex medical claims issues to support timely processing.
Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
Utilized specialized software to process incoming claims, enter data and generate reports.
Evaluated accuracy and quality of data entered into agency management system.

Patient Benefits Specialist

UnitedHealth Group

06.2021 - Current

Assist Patients with billing inquiries
Update insurance and submit EOB for payment
Update patients’ demographics.
Collaborated with internal departments and external vendors to achieve fast resolution of claims.
Updated claims system to track claim status and provide relevant information to other departments.
Developed an in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
Maintained accurate and up-to-date records of claim information for future reference.
Modified, updated, and processed existing policies.
Analyzed and addressed escalated claims to resolve issues quickly
Updated claims system to track claim status and provide relevant information to other departments
Posted payments to accounts and maintained records
Modified, updated and processed existing policies
Provided advice to customers regarding claims, rights and insurance processes to prevent disputes
Processed and recorded new policies and claims

Patient Service Representative

Robert Half Staffing Agency/Change Health Care

09.2020 - 06.2022

Provided exceptional customer service to patients, answering questions and addressing concerns.
Entered patient demographic in electronic medical record system for NYC CARE Application.
Filed and maintained patient records in accordance with HIPAA regulations.
Managed patient registration process, confirming data accuracy and completeness.
Used EPIC to schedule appointments.
Facilitated communication between patients and various departments and staff.
Provided exceptional customer service to patients, answering questions and addressing concerns
Entered patient demographic and insurance data into the electronic medical record system
The managed patient registration process, confirming data accuracy and completeness
Built and maintained positive working relationships with patients and staff
Verified insurance eligibility and coverage for patients
Verified patient insurance eligibility and entered patient information into the system
Processed payments using cash and credit cards, maintaining accurate records of transactions
Facilitated communication between patients and various departments and staff
Followed document protocols to safeguard confidentiality of patient records
Applied administrative knowledge and courtesy to explain procedures and services to patients

Child Care Provider

Children of The Future, FDCC

05.2016 - 03.2021

Supervise indoor and outdoor activities of children
Keep records of children's growth, development and behavior
Develop activities to keep children engaged
Help children in understanding and following instructions
Encourage children in performing tasks by themselves
Help children with daily routines such as dressing, toileting, eating and sleeping
Prepare meals and snacks to fulfill nutritional needs of children
Maintain environment very clean, appealing and safe
Provide guidance on children's behavior and social development
Sanitized dishes, tabletops, toys, and frequently touched surfaces to prevent spreading of germs
Prepared healthy foods and beverages for children based on optimal dietary guidelines and individual restrictions
Taught children to organize toys, wash hands, and share by leading by example

CSR

UncommonGoods/ Robert Half

11.2019 - 01.2020

Monitor and handle daily exceptions with customer orders, which includes but is not limited to:
Processing returns and Credits via Braintree, PayPal, Border free (Pitney Bowe)
Follow up with outstanding customer orders via Ug Admin
Contact customer via phone and email thru Zendesk.

Accounts Receivable Clerk

Coltronics/ Robert Half

07.2019 - 10.2019

Assist Client with inquiries with product information and placing orders
Process daily order into Sage system for processing and delivery
Manage daily invoices and miscellaneous entries into accounts receivable system
Manage all credit card payment and log daily entry in to Sage and Omny system
Assist the office with all operational duties.

Patient Service Representative

Maximus/ Robert Half

10.2018 - 05.2019

Actively reach out to member for enrollment and administration update., Responds to enrollment services calls, provides responses to questions, mails information in response to request, and refers callers in the event of problems or concerns
Educates clients on managed care
Assesses clients' health care needs and assists clients in choosing a health plan
Maintains updated knowledge of the New York Medicaid CHOICE Project
Assists clients in enrolling/disend-roiling in health plans.

Operations Associates

East Harlem Scholars Academy

11.2015 - 04.2016

Answering Phones, transferring calls, and relaying messages greeting and directing visitors
Maintaining a neat and tidy main office and Distribution of mail
Compiling and sending out daily attendance report
Assisting in arrival, dismissal, and lunch duties and escorting the sick to the nurse room
Keeping the school's databases up to date with student information (ATS and Power school)
Event Assistant- lottery, family nights, Schools open house and parent-teacher conference/IEP meetings translator
Assisting in the setup and cleanup of school-wide events
Assisting the principal, Operations Manager, and Director of Operations as needed
Actively contributing to the warm familial feel to the school's main office

Administrative assistant

Academy of the City Charter School

08.2014 - 09.2015

Report to Director of Operation and Principal
Manage the reception area, including greeting visitors, students and responding to telephone and in-person requests for information
Serve as a liaison between principal, teachers and parents
Manage ordering of school supplies, textbook and maintenance and inventory of such
Data entry/record keeping using excel and ATS
Responsible of registration and record keeping of students in ATS
Manage lunch tracking, logging and completion of IME’s reports send to DOE Schools food
Prepare and record keeping of invoices to be given to accountant, processed an average of 200 invoices per month for the school
Calculate figures such as discount, percentage allocations and credits
Research and resolve billing and invoice problems
Coordinate approval processes of all account payable invoices
Developed more efficient filing systems and student database protocols

Bilingual Operations Assistant, •Gatekeeper/Receptionist

Central Queens Academy Charter School

03.2014 - 06.2014

Greet student, parents, visitors and provide late and visitor pass
In charge of Inventory of supplies tracking and distributer of such to staff
Serve as a liaison between principal, teachers and parents
Student lottery intake and admission support
Event Assistant- lottery, family nights, Schools open house and parent-teacher conference translator
Data entry/ record keeping using Mealtime, Kickboard and ATS
Assist Principal and all staff in making copy of lesson plans or any other instructional material needed
All school support such as attendance distributor/ collector, lunch scanner and dismissal officer

Bilingual Administrative Assistant

East Harlem Scholars Academy

11.2013 - 01.2014

Answering Phones, transferring calls, and relaying messages and greeting and directing visitors
Maintaining a neat and tidy main office and Distribution of mail
Compiling and sending out daily attendance report
Assisting in arrival, dismissal, and lunch duties and escorting the sick to the nurse room
Keeping the school's databases up to date with student information (ATS and Power school)
Assisting in the setup and cleanup of school-wide events
Assisting the principal, Operations Manager, and Director of Operations as needed
Actively contributing to the warm familial feel to the school's main office

Administrative Aide/ Acct Payable

Global Employment/ New York University

06.2012 - 10.2013

Space Planning and Management
Created and maintained spreadsheets on excel for housekeeping services
Maintained records of all payments and invoices of housing rental
Purchased office and cleaning supplies – contacted vendors and subcontractors
Wagner NYU Account Payable/ Data Entry
Entered information from important documents into The Company database with great accuracy
Scheduled conference rooms, prepared agendas, and maintained calendars to prepare for meetings and events.
Booked airfare, hotel, and ground transportation to coordinate office travel.
Coordinated and scheduled meetings and conference calls to optimize scheduling of senior staff.
Restocked supplies and placed purchase orders to maintain adequate stock levels.
Compared data from original sources to monitor mistakes and posted in database
Corrected mistakes and compared data received from departments before inputting to database
Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
Advice applicants, student and parents on financial Aid application process, University policies and procedure.
Provide complex and detailed financial Aid information in terms parents and students can easily understand.

NYU/ Financial Aid-Customer Services Representative

Global Employment Solutions

06.2012 - 09.2013

Advice applicants, student and parents on financial Aid application process, University policies and procedure
Assist with resolving problems including serving as liaison to other University offices
Provide complex and detailed financial Aid information in terms parents and students can easily understand.

Carlton Hotel / Account receivable clerk

Robert Half Company

11.2011 - 04.2012

Prepared and mailed invoices to customers, processed payments, and documented account updates.
Followed up overdue payments and payment plans from clients to establish good cash flow.
Submitted cash and check deposits and generated cash receipts to record money received.
Monitored accounts to verify compliance with payment terms and schedules.

Account receivable clerk

Hilton Tower Hotel

09.2007 - 10.2010

Process daily invoices and miscellaneous entries into accounts receivable system
Trace, calculate, and prepare check request of group commissions
Prepare, print, adjust and mail accounts statement
Adjust, prepare and invoice FIT groups.
Assist with guest history inquiries.

Medical Center/Administrator Assistant

Winston Staffing Services, LLC

02.1998 - 05.2006

Responsible for answering phone and scheduling new apt
Type, Files, and distributes correspondence as directed
Assist in scheduling staff coverage for in hospital schedule
Arrange and schedule surgery in accordance with Hospital policies
Post and reconcile insurance and patient payments
Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts

Claim Examiner

Metropolitan Jewish Corporation/Winston Staffing

03.2000 - 03.2001

Data entry
Processed all types of pended claims
Insure accuracy of insurance claims
Verify correct ICD-9 and CPT codes for a variety of specialties
Examined claims forms and other records to determine insurance coverage.
Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Researched claims and incident information to deliver solutions and resolve problems.

Membership Services Representative

International Trademark Association, INTA

09.1996 - 12.1997

Provide information on trademark patent and copyrights
Answer inquiry of upcoming meeting as well as provided counsel to the benefit of membership
Enter new member on CEI and PSI Data System
In charge of inventory control proceeding of news and credit cards
Answered multi-line telephone, routed calls, and took accurate messages

Cashier/Sales Associates

GAP Inc, BANANA REPUBLIC

09.1991 - 05.1996

Operate of cash registered and training of new cashiers and assist customer on the sale floor
Organized and display new merchandise on the sale floor and responsible for visual
Responsible for visual display and appeal of jewelry and inventory specialist on this division

Claims Processor

Optum

10.2023 - Current

Managed workload and priorities to meet claims processing meet deadlines.
Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
Verified patient insurance coverage and benefits for medical claims.
Researched and resolved complex medical claims issues to support timely processing.
Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
Utilized specialized software to process incoming claims, enter data and generate reports.
Evaluated accuracy and quality of data entered into agency management system.

Summary

Overview

Work History

Claims Processor

Patient Benefits Specialist

Patient Service Representative

Child Care Provider

CSR

Accounts Receivable Clerk

Patient Service Representative

Operations Associates

Administrative assistant

Bilingual Operations Assistant, •Gatekeeper/Receptionist

Bilingual Administrative Assistant

Administrative Aide/ Acct Payable

NYU/ Financial Aid-Customer Services Representative

Carlton Hotel / Account receivable clerk

Account receivable clerk

Medical Center/Administrator Assistant

Claim Examiner

Membership Services Representative

Cashier/Sales Associates

Claims Processor

Education

B.A - Psychology

Skills

Languages

Timeline

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