Summary
Overview
Work History
Education
Skills
Timeline
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CHANTEL BONILLA

Duluth,GA

Summary

Accomplished healthcare professional who proudly maintains a highly productive, efficient and quality - driven focus at all times. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards.

Overview

9
9
years of professional experience

Work History

Documentation Specialist

Nuance Communications Inc a Microsoft Company
10.2021 - Current
  • Process and complete all Initial and Re-Credentialing applications for IPA/PAMF physicians and allied health providers for over 500 providers, ensuring accuracy of information and NCQA standards are met
  • Responsible for health plan notifications for new/termed providers, TIN changes, status changes and maintain database integrity
  • Prepare and update provider profiles and format rosters to meet each health plans specific requirements
  • Actively participated in Delegated Health Plan/ICE audits by ensuring all files were accurate and updated which resulted in 100% audit scores
  • Assisted supervisor with preparing and presenting monthly credentialing committee meetings with IPA physician leaders
  • Worked closely with UM, Quality Assurance and Provider Relations departments to resolve managed care eligibility issues and ensure on site visits were conducted
  • Reviewed on going monitoring sites monthly for derogatory incidents and reported to Medical Director and Board for review and compliance with NCQA/IMQ guidelines., Using a multidisciplinary team approach the Quality Documentation Specialist facilitates and obtains appropriate clinical documentation for any clinical conditions or procedures to support the proper severity of illness, expected risk of mortality, and complexity of care of the patient
  • Training, exhibits a detailed knowledge of clinical documentation requirements, and DRG assignment, as well as a firm understanding of coding guidelines
  • The CDIS educates members of the patient care team regarding clinical documentation guidelines, including attending physicians, allied health practitioners, and nursing
  • Reviews medical records using EPIC concurrently on a daily basis to identify opportunities to improve the quality and completeness of clinical documentation
  • Facilitates modifications to clinical documentation when appropriate, through extensive concurrent interaction with physicians, mid-level providers, HIM staff, allied health professionals, and nursing staff to support accurate, complete, and timely documentation of clinical information in the electronic patient record
  • Coached and educated physicians, mid-level providers, HIM staff, allied health professionals, and nurses on a daily basis to improve the capture of clinical severity for the level of service rendered to patients.
  • Transmitted documents, organized revisions and tracked changes.
  • Completed transmittal logs and stored in files for specified durations.
  • Maintained document archive and file server of approved documents and drawings to provide easy traceability and retrievability.
  • Collaborated with quality assurance team to comply with regulatory requirements.
  • Translated complex technical information into intuitive clear format.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Updated account information to maintain customer records.
  • Answered constant flow of customer calls with minimal wait times.
  • Responded to customer requests for products, services, and company information.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Clarified customer issues and determined root cause of problems to resolve product or service complaints.

Customer Service Supervisor

Publix
11.2015 - 09.2021
  • Coached employees through day-to-day work and complex problems.
  • Responded to customer inquiries and resolved complaints to establish trust and increase satisfaction.
  • Developed and maintained strong relationships with customers to maintain loyalty and satisfaction.
  • Conducted training and mentored team members to promote productivity and commitment to friendly service.
  • Coached team members to deliver hospitable, professional service while adhering to set service models.
  • Actively supported service associates by quickly responding to questions via phone and email and finding appropriate solutions to customer issues.
  • Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
  • Created, prepared, and delivered reports to various departments.
  • Monitored metrics and developed actionable insights to improve efficiency and performance.
  • Led regular customer service meetings to review progress identify challenges and provide feedback.
  • Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
  • Implemented feedback system for customers to provide comments and suggestions to improve service.
  • Delegated tasks to administrative support staff to organize and improve office efficiency.
  • Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
  • Interceded between employees during arguments and diffused tense situations.
  • Coordinated individual duties after careful evaluation of each employee's skill level and knowledge.
  • Kept high average of performance evaluations.
  • Developed internal requirements and standards to minimize regulatory risks and liability across programs.
  • Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
  • Implemented project management techniques to overcome obstacles and increase team productivity.
  • Managed supervisor itinerary and appointments and streamlined scheduling procedures.
  • Organized spaces, materials and catering support for internal and client-focused meetings.
  • Improved office operations by automating client correspondence, record tracking and data communications.

Claims Representative

CVS Health
01.2015 - 11.2015
  • Maintained accurate and up-to-date records of claim information for future reference.
  • Collaborated with internal departments and external vendors to achieve fast resolution of claims.
  • Interviewed policyholders to verify information and obtain additional details.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Analyzed and addressed escalated claims to resolve issues quickly.
  • Updated claims system to track claim status and provide relevant information to other department.
  • nvestigate, analyze, and process insurance claims for policyholders.
  • Review policy coverage and applicable documentation to determine claim eligibility.
  • Communicate with policyholders, agents, and third-party service providers to gather necessary information and documentation.
  • Evaluate damages, injuries, or losses and determine the extent of the insurance company's liability.
  • Negotiate settlements with claimants and ensure timely payment processing.
  • Maintain accurate records of claims, settlements, and related correspondence.
  • Collaborate with legal and medical professionals when necessary to assess complex claims.
  • Keep up-to-date with industry regulations and policy changes to ensure compliance.
  • Achieved an average claim resolution time 20% faster than departmental benchmarks.
  • Examined reports, accounts, and evidence to determine integrity and accuracy of information.
  • Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
  • Monitored and managed claim expenses to control costs and maximize profitability.
  • Prepared and presented detailed reports to management on claims issues to aid in decision making.
  • Verified client information by analyzing existing evidence on file.
  • Generated, posted and attached information to claim files.
  • Checked documentation for accuracy and validity on updated systems.
  • Calculated adjustments, premiums and refunds.
  • Modified, updated and processed existing policies.
  • Collected premiums and issued accurate receipts.
  • Processed and recorded new policies and claims.
  • Coordinated with contracting department to resolve payer issues.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Posted payments to accounts and maintained records.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Researched and analyzed complex claims to determine next steps and possible outcomes.
  • Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.

Resident Assistant

Georgia State University
  • Managed a floor of 45 upperclassmen residents
  • 25-30 of those residents are student-athletes Worked on responding to building emergencies and writing reports based on events that occur during emergencies
  • Required to work with other resident assistants to make residential life more enjoyable
  • Maintained a clean, safe, and well-organized patient environment.
  • Changed bed linens, dumped trash, and smoothly handled maintenance issues to promote resident comfort.
  • Mediated conflict resolution with roommates and other residence hall members to promote peace, order, and positive relationships.
  • Monitored and inspected residence hall rooms to determine safety and manage maintenance issues.
  • Developed and implemented programs, study groups, and mentoring to promote student success.

Education

Duluth High School
Duluth, GA

Skills

  • Claims Preparation
  • Liability Determinations
  • Premium Calculations
  • Personal Data Evaluation
  • Constructive Feedback
  • Microsoft Office
  • Data Communications
  • Insurance Terminology
  • Settlement Verification
  • Recordkeeping Organization
  • Settlement Determinations
  • Payment and Investigation Escalations
  • Policy Requirements and Eligibility
  • Account Management Software
  • Electronic Authorization Processing
  • Data Quality
  • Policy Modification
  • Past Due Balance Management
  • Work Organizing and Prioritizing
  • Cancellation Notifications
  • Policy and Procedure Explanations
  • Strategic Initiatives
  • Accident Investigations

Timeline

Documentation Specialist

Nuance Communications Inc a Microsoft Company
10.2021 - Current

Customer Service Supervisor

Publix
11.2015 - 09.2021

Claims Representative

CVS Health
01.2015 - 11.2015

Resident Assistant

Georgia State University

Duluth High School

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CHANTEL BONILLA