Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Berenice Olmedo

South Amboy,New Jersey

Summary

To build a career that offers experience and opportunities to enrich my knowledge and skills, all the while contributing to the organization and my personal growth.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Provider Relations Representative

Hamaspik Choice
Spring Valley, New York
11.2021 - Current
  • Responsible for Out of Network Agreements, building and maintaining a relationship between providers and insurance plans
  • Triage incoming communication from providers via phone, email and fax
  • Assist providers with inquiries or concerns regarding plan participation, out of network authorizations, billing concerns and demographic information
  • Responsible for receiving, documenting, uploading and entering requests for out of network authorization from providers and/or third-party billing companies
  • Generating Single Case Agreements for out of network providers upon receipt of a cover sheet from our Utilization Management team in Access
  • Forwarding Single Case Agreements to the correct party for authorization signatures
  • Continually follow up with providers for documentation, signatures, questions or concerns regarding requests
  • Storing and documenting received Single Case Agreements to Access and Excel to present to the Executive team for countersignature
  • Distributing countersigned Single Case Agreements to correct providers while uploading the document to Guiding Care
  • Creating and maintaining updated accounts for providers in Salesforce and QNXT
  • Aid with miscellaneous projects within the department
  • Assist other departments with requests to update provider demographics, contracts or rate questions
  • Train incoming staff on the Single Case Agreement process, Salesforce and QNXT entries, and entering requests into Guiding Care

Stock-Cashier- Pricing

OLD NAVY
West Nyack, New York
11.2012 - 01.2023
  • Performed day to day operations within the retail chain in the Palisades Mall
  • Greeted customers upon arrival; assisted in inquiries regarding promotions, procedures on returns and sales
  • Aided in recovering the store at the end of the night by ensuring that all merchandise is properly displayed and all areas cleaned
  • Processed transactions quickly and accurately according to company policies, ensuring the customer receives the highest level of customer service

Medical Billing Representative

MedStar Consulting
Pomona, New York
11.2018 - 11.2021
  • Assisted in handling billing and insurance related phone inquiries from patients, doctors, and insurance representatives
  • Responsible for daily submission of electronic or paper claims to both primary and/or secondary insurance companies
  • Reviewed and verified precertification’s for medical procedures prescribed by the doctors
  • Researched patient eligibility with insurance companies regarding medical procedures and doctor visits
  • Reviewed and researched billing errors related to submission and/ or insurance errors
  • Submitted billing claims to Medicare, Medicaid and other State programs using HCFA and other required billing submission forms
  • Collected and posted payments based on patient visits, utilizing my knowledge of insurances to explain coverage and benefits to patients
  • Experienced in the use of ICD9 and ICD10 for coding and billing of medical claims

Patient Representative

Hudson River Healthcare
Haverstraw, New York
06.2015 - 02.2018
  • Responsible for supporting community liaison with questions to take part in HRH program
  • Managed incoming calls and resolving patient inquiries, forwarding calls to the correct department
  • Collecting and posting payments based on patient visits, utilizing my knowledge of insurances to explain coverage and benefits to patients
  • Built Relationship with Community to educate on HRH Cares programs
  • Recruited new members VIA events and healthcare fairs throughout Hudson County

Head Cashier

FOOT LOCKER
Yonkers, New York
01.2015 - 01.2018
  • Senior member of the Cashier Group
  • Responsible for training and day to day operations within the cashiering group
  • Aid in training junior cashiers in all aspects of the register, including counting out the register at the end of each shift
  • Process all transactions, including sales, returns and orders
  • Process order request for customers
  • Prepare bank deposits and daily reports at the end of the night
  • Aid in processing new merchandise for incoming review and inventory
  • Setting up visuals and mannequins, displaying proper price changes

Education

Cardiovascular Sonograms, Medicals Assistant, EKG, Phlebotomy

Eastwick College
Ramsey, NJ
12.2021

Skills

  • E Clinical Works (ECW)
  • DentaQuest
  • TIGER
  • HealthPlex
  • Claim Remedi
  • MS Word
  • Excel
  • Power Point
  • HealthPAC
  • QNXT
  • Guiding Care
  • Access
  • Salesforce
  • Communication and Team player skills
  • Problem Solving
  • Leadership and Motivation skills
  • Planning and Organization
  • Skilled in money management

Certification

  • Certified Phlebotomist, Eastwick College, Ramsey, New Jersey
  • CPR Certification, Eastwick College, Ramsey, New Jersey

Timeline

Provider Relations Representative

Hamaspik Choice
11.2021 - Current

Medical Billing Representative

MedStar Consulting
11.2018 - 11.2021

Patient Representative

Hudson River Healthcare
06.2015 - 02.2018

Head Cashier

FOOT LOCKER
01.2015 - 01.2018

Stock-Cashier- Pricing

OLD NAVY
11.2012 - 01.2023

Cardiovascular Sonograms, Medicals Assistant, EKG, Phlebotomy

Eastwick College

Similar Profiles

CREATE PROFILE
Berenice Olmedo