Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Cesarina Santana

Buford,GA

Summary

Experienced and highly motivated team player with over 20 years of experience in the healthcare administrative field. Seeking affiliation with a dynamic organization that provides opportunities for professional development and advancement. Adept at managing multiple tasks, prioritizing workloads, and collaborating with diverse teams to achieve organizational goals.

Overview

24
24
years of professional experience
1
1
Certification

Work History

Room Control Specialist

NORTHSIDE HOSPITAL DULUTH
02.2020 - Current
  • Facilitate the House Coordinator with assigning appropriate rooms via a computerized system, eStar and Cerner, based on the patient's level of care.
  • Reserve rooms for direct admissions coming from other hospitals, doctor’s offices, and from home.
  • Create new accounts, and verify insurance eligibility prior to admission.
  • Oversee timely discharge of patients to expedite the admissions of holds in the Emergency Room
  • Update diagnosis, level of care and attending physicians in EMR records.
  • Review surgery reports to ensure accounts are converted to the right billing type.
  • Train and serve as a mentor to new team members by developing a Room Control Guide Book, as well as coaching and instructing them on a one to one basis on processes and policies.

Preauthorization Representative

NORTHSIDE HOSPITAL DULUTH
11.2018 - 02.2020
  • Secured authorizations from commercial, government and CMO payers for Diagnostic procedures, such as, CT’s, MRI’s, MRA’s, CTA’s and Echo, Cath, Holters & Event monitors, ultrasounds, and biopsies.
  • Estimated patient’s financial responsibility prior to their appointments.
  • Surpassed to meet daily goals of 32 or more accounts to completion for appointments scheduled five days out.
  • Managed the Authorization phone line, where patients inquired on the status of authorization prior to their appointment.
  • Ensured the correct insurance plan was assigned to the accounts.
  • Procured referrals and doctor’s orders prior to authorizing procedures.

Patient Account Representative

GWINNETT MEDICAL GROUP
08.2016 - 03.2018
  • Responsible for scrubbing claims to ensure timely submission of claims electronically or on claim forms.
  • Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
  • Verified insurance information, eligibility, prior authorization, and referrals using different insurance portals.
  • Addressed patients’ inquiries over the phone regarding statements, balances, and insurance notifications.
  • Secured and processed outstanding balance over the phone and in person.
  • Appealed denied and underpaid claims.
  • Prepared and processed medical records request from payers.
  • Confirmed and approved insurance and patient refund requests.
  • Worked with outside entities to resolve issues with billing, claims, and payments.

Insurance Billing Associate

RYDER SYSTEM INC
11.2015 - 05.2016
  • Acquired proper documentation to setup collisions in FIS system.
  • Collaborated with shops and rental counters to secure missing collision information.
  • Expressed potential liability issues to Ryder National Liability Claims Office.
  • Partnered with billing analyst department to investigate and remedy any gross margin trend issues.
  • Generated invoices of damage repairs for customers.
  • Streamlined the invoicing process for increased efficiency, utilizing automated billing software and systems.

Support Services Representative

HCA - PARALLON BUSINESS PERFORMANCE GROUP
03.2014 - 01.2015
  • Accurately recorded details of customer calls and issues on logging software.
  • Consistently met or exceeded performance metrics while maintaining high levels of customer satisfaction.
  • Actively answered questions regarding account statements and grievance resolution.
  • Cooperated with the Finance department with claims processing.
  • Assessed accounts for appeal requests and forwarded inquiries to the appropriate departments.
  • Reconciled accounts according to insurance contracts and updated insurance information.
  • Processed payment transactions.
  • Reviewed, prepared, and mailed medical records requests while maintaining HIPAA compliance.

Billing Assistant

NYU LANGONE MEDICAL CENTER AT TRINITY CENTER
03.2008 - 10.2013
  • Improved billing accuracy by diligently reviewing and verifying invoice data before submission.
  • Maintained updated records of all transactions and invoices, ensuring easy access and retrieval when needed.
  • Assigned appropriate International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) codes on accounts.
  • Provided information regarding resources for patients who needed financial assistance.
  • Produced and mailed invoices, payment reminders, and financial notices.

Medical Biller

MADISON MEDICAL GROUP
02.2004 - 07.2006
  • Responsible for the billing of four Physical Therapists
  • Assigned appropriate ICD, CPT and HCPCS codes
  • Followed-up on submitted and/or denied claims
  • Submitted claims to second and third-party insurances
  • Processed patient statements and billing
  • Posted transactions.

Medical Biller

LARRY J SHEMEN, M.D.
01.2001 - 02.2004
  • Ensured submission of claims and followed up on reimbursement.
  • Submitted appeals on denied and/or underpaid claims.
  • Assigned proper ICD-9, CPT-4 codes and modifiers to claims
  • Scrubbed and submitted paper and electronic claims.
  • Processed claims.
  • Filed and updated patient information and medical records.
  • Posted payments and collections on regular basis.
  • Reduced claim denials by meticulously reviewing patient insurance information and coding practices.

Education

Associates Degree in Math and Science -

LaGuardia Community College
Long Island City, New York

Skills

  • Bilingual: Fluent in Spanish
  • First Aid and CPR Certified
  • Proficient in MS Office including Word, Excel, and Outlook
  • eSTAR
  • Cerner, Epic, Eclipse, MDBase, and Doc-torcom, AS400 Passport OneSource and Navinet
  • Star, Huron (Aeos), PHS (BEM), OneContent, and RevRunner, GEMMS, Clearwave, Zirmed, Availity, and Evicore, GAMMIS UHC Website
  • Teamwork and Coordination
  • Strong Work Ethic
  • Problem-Solving

Certification

Certified Patient Account Representative (CPAR)

Timeline

Room Control Specialist

NORTHSIDE HOSPITAL DULUTH
02.2020 - Current

Preauthorization Representative

NORTHSIDE HOSPITAL DULUTH
11.2018 - 02.2020

Patient Account Representative

GWINNETT MEDICAL GROUP
08.2016 - 03.2018

Insurance Billing Associate

RYDER SYSTEM INC
11.2015 - 05.2016

Support Services Representative

HCA - PARALLON BUSINESS PERFORMANCE GROUP
03.2014 - 01.2015

Billing Assistant

NYU LANGONE MEDICAL CENTER AT TRINITY CENTER
03.2008 - 10.2013

Medical Biller

MADISON MEDICAL GROUP
02.2004 - 07.2006

Medical Biller

LARRY J SHEMEN, M.D.
01.2001 - 02.2004

Associates Degree in Math and Science -

LaGuardia Community College

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