Carissa RAMIREZ
Whiting,IN
Summary
Proven track record in enhancing care review processes at Molina Healthcare, showcasing adaptability and HIPAA compliance. Excelled in medical billing and dispute resolution, significantly reducing claim denials. Microsoft Office mastery to drive improvements, demonstrating a commitment to excellence and results. Care Review Processor checks eligibility and verifies benefits, obtains and enters data into systems. Employs strong knowledge of medical terminology and abbreviations with high regard for confidential information.
Overview
9
9
years of professional experience
Work History
Care Review Processor
Molina Healthcare
01.2021 - Current
- Streamlined WA census reports, training others on the process and creating forms for easy processing. Maintained Peer to Peer email box, scheduling and overseeing meeting invites.
- Maintained confidentiality at all times while handling sensitive patient information according to HIPAA regulations during the execution of daily tasks related to care reviews.
- Demonstrated adaptability by effectively adjusting to changes in departmental priorities or processes as needed to meet evolving patient care needs. Medicare, Marketplace and Peer to Peer knowledge.
- Promoted a culture of continuous improvement by actively participating in training sessions, workshops, and professional development opportunities related to care review processing.
- Maximized productivity levels within the department through careful prioritization of tasks and effective time management techniques. Resolved issues quickly to maintain productivity goals.
Medical Billing Clerk
South Shore Hospital
04.2018 - 01.2021
- Posted payments and collections on regular basis.
- Collaborated with healthcare providers to ensure proper documentation was submitted for accurate claim processing, reducing denials due to incomplete or incorrect information.
- Developed strong working relationships with insurance companies, fostering effective communication for swift resolution of claim issues.
- Assisted patients with inquiries regarding bills, providing clear explanations of charges and answering questions related to insurance coverage or payment options.
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
Customer Service Representative
MB Financial
03.2015 - 03.2017
- Resolved complex customer situations by utilizing problem-solving skills and escalating issues when necessary.
- Maintained strict adherence to compliance regulations, ensuring all transactions were accurately processed and documented.
- Processed daily cash transactions accurately while adhering to security protocols, minimizing risk exposure for the bank and its customers.
- Supported branch sales goals with effective cross-selling of banking products, increasing overall revenue.
- Identified potential growth opportunities for both clients and the bank by carefully assessing customer profiles and financial goals.
Education
Associate of Applied Science - General Studies
City Colleges of Chicago-Harold Washington College
Chicago, IL07.2018
Skills
- HIPAA Compliance
- Collaboration and Teamwork
- Adaptable and Flexible
- Computer Proficiency
- Insurance Authorizations
- Medical Billing
- Insurance claims processing
- Denial Management
- Microsoft Office
- Research abilities
- Documentation and Recordkeeping
- Dispute Resolution
Timeline
Care Review Processor
Molina Healthcare
01.2021 - Current
Medical Billing Clerk
South Shore Hospital
04.2018 - 01.2021
Customer Service Representative
MB Financial
03.2015 - 03.2017
Associate of Applied Science - General Studies
City Colleges of Chicago-Harold Washington College
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