Summary
Overview
Work History
Education
Skills
Accomplishments
References
Languages
Timeline
Generic

Claudia Rosell

Miami,FL

Summary

Seeking a company to grow with and utilize my skills for its development. Top-notch Contract Administrator with extensive experience in contract management and negotiations. Strong problem-solving and critical-thinking skills with good understanding of legal concepts and contract law. Collaborative and dedicated to delivering outstanding customer service.

Overview

13
13
years of professional experience

Work History

CONTRACT ANALYST

Cano
08.2022 - Current
  • Research potential providers online utilizing spend data and set appointments to join the Accountable Care Organization network
  • Create meetings via Microsoft Teams and present providers the benefits of joining large ACO REACH network
  • Create leads on Salesforce and manage them successfully
  • Review Medicare and legal contracts to ensure they are compliant
  • Negotiate contract terms
  • Create pivot tables and v-look up for large providers
  • Gained the most national contracts in the company after a few months being employed.

RCM Supervisor

UHC
01.2018 - 08.2022
  • Entered Medicare and commercial payor payments on each claim
  • All payments and/or adjustments are reviewed and processed correctly
  • Team Macro Champ: I repaired all processors with any system macro issues that interrupt workflow
  • Back up Subject Matter Expert: I assisted processors with financial and process-based questions
  • Assist Subject Matter Experts with TTP and ECOB reports: I reviewed financial accounts that were processed incorrectly and help guide processors on how to correctly solve problems based on the company’s Standard Operation Practices
  • Assisted states such as: VA, NM, PA, NY, MO, and Texas with backlog of claims when needed
  • Processed all Covid related claims to make sure payment overrides are made.
  • Managed payroll processing for 20 employees using ADP software
  • Reviewed resumes and set up interviews with potential employees
  • Processed medical claims via provider portals
  • Successfully managed provider credentialing for commercial and government insurances
  • Managed payment posting from insurance companies
  • Created office handbooks and policies
  • Processed background checks
  • Successfully managed accounts payable and receivable
  • Created and mailed out checks for vendors when necessary
  • Handled end of month reporting via Excel spreadsheet.

Account Administrator

Pediatrix Medical Group
02.2011 - 03.2017
  • Followed up on all Medicaid out of state and Florida hearing screen accounts
  • Handled Florida in and out of state Neonatology accounts
  • Contacted patients for hospital in-patient services rendered to newborns when necessary
  • Researched online website for insurance verification and claim status
  • Worked together with provider enrollment department making sure FL Medicaid providers were credentialed and crosswalk matched claims
  • Worked on FL Medicaid provider non-payment issues and resolved it for all facilities
  • Neonatology Collection Admin-Followed up on all Atlantic region neonatal accounts
  • Handled BCBS accounts for proper account follow up
  • Worked on credit balance accounts
  • Created healthcare provider applications to mail out to health plans
  • Attended practice calls to provide each practice an update on provider applications
  • Helped peers with assignments created for providers.
  • Created insurance follow-up reports and called all major private and government insurance
  • Credentialed medical doctors in all private, commercial, and government health insurance companies
  • Handled provider licenses, W9, and CV’s
  • Worked/followed-up on all orthopedic large balance account for payment
  • Corrected coding issues based on AMA coding guidelines
  • Created Excel spreadsheets for doctors and management such as: medical coding data, charges for all procedure codes and A/R outstanding balances
  • Posted/adjusted payments
  • Attended billing workshop with manager
  • Liaison for several doctor offices and Medstar.

Education

bachelor of science pre-medicine -

Bachelor of Science - Accounting And Business Management

University of Maryland - Baltimore County
Baltimore, MD

Bachelor of Arts - English Literature Honors

Saint Thomas University
Opa-locka, FL
01.2008

High School Diploma - Magnet Program

Miami Carol City Senior High School
Miami Gardens, FL
01.2002

Skills

  • Microsoft Office
  • Salesforce CRM
  • Proficient in Excel
  • Attention to Detail
  • Contract drafting
  • Legal Research
  • Ethics and integrity
  • Contract reviews and edits
  • Contract performance monitoring
  • Document Review
  • Workflow Management
  • Professional relationship building

Accomplishments

  • BA in English Literature with a minor in Education (Honors).
  • University of Maryland: Financial Accounting-In process
  • Harvard EDX online Contract Law certificate 2017.

References

  • Cynthia Martinez/United Healthcare Florida Supervisor
  • Brenda Alonso/ Workforce UHC
  • Nancy Figueroa/Prizmcare Director

Languages

Spanish
Native or Bilingual
English
Native or Bilingual

Timeline

CONTRACT ANALYST

Cano
08.2022 - Current

RCM Supervisor

UHC
01.2018 - 08.2022

Account Administrator

Pediatrix Medical Group
02.2011 - 03.2017

bachelor of science pre-medicine -

Bachelor of Science - Accounting And Business Management

University of Maryland - Baltimore County

Bachelor of Arts - English Literature Honors

Saint Thomas University

High School Diploma - Magnet Program

Miami Carol City Senior High School

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Claudia Rosell