Daniela A. Jimenez

Queens Village,NY

Summary

Insurance Operations Associate with a bias for action and 5+ years of experience in high volume medical legal environments. Expert in triaging complex No Fault and Workers’ Compensation denials, investigating legal insurance logic, and optimizing operational workflows through data driven solutions. Proven track record of developing Excel based tracking systems and training departmental staff on standardized documentation and compliance protocols.

Overview

years of professional experience

Work History

Senior Lien Medical Collector / Operations Lead

New York Spine Specialist

05.2022 - Current

Operational Optimization: Investigated and resolved complex billing bottlenecks by engineering custom Excel frameworks to track lien reductions and payments, providing data driven insights to leadership.
Departmental Training & Strategy: Spearheaded the onboarding of the entire department and virtual assistants; authored comprehensive training guides and competency modules to ensure 100% documentation accuracy.
Denial Triage & Investigation: Managed complex lien recovery for Personal Injury and No Fault claims; collaborated with Revenue Cycle Managers to secure PIP ledgers and Declaration pages for eligibility audits.
Standardization: Designed a centralized suite of professional templates (Arbitration notices, Lien agreements) that reduced manual errors and improved communication turnaround with law firms.
Cross Functional Collaboration: Acted as a bridge between legal and medical departments to mediate settlements and ensure seamless recovery in Section 32 Workers' Compensation cases.

Patient Coordinator

Spine Associates (Sean E. McCance MD)

12.2021 - 04.2022

Process Management: Audited patient charts and insurance demographics across multiple facility portals (NYU Langone, Lenox Hill) to ensure data integrity.
Authorization Specialist: Investigated insurance logic to confirm treatments were fully authorized, preventing billing denials before service.
Financial Compliance: Facilitated the final stage of the intake process by presenting prepared insurance verifications and Out of Network (OON) Payer Notices to patients, ensuring all financial acknowledgments were executed and filed correctly.

Front Desk Receptionist

NY Med Diagnostic & Treatment Center (Article 28)

07.2020 - 12.2021

Intake Data Integrity: Managed patient registration and record preparation for Workers Compensation, No Fault, and Lien cases, ensuring 100% accuracy in demographic and insurance data to support downstream billing workflows.
Revenue Cycle Support: Facilitated the collection of co-pays and the execution of financial disclosures; ensured all Out-of-Network (OON) Payer Notices were accurately presented, signed, and filed.
Claims Documentation: Audited patient charts to ensure all critical billing documents—including insurance cards, face sheets, and HIPAA authorizations—were complete and audit ready.
Operational Coordination: Managed multi line communications and triaged office requests (faxes, emails, and medical record requests) to maintain a seamless flow of information between departments.
Compliance Monitoring: Maintained facility and patient record organization in strict accordance with Article 28 and CDC guidelines, ensuring data privacy and operational safety.

Education

Liberal Arts Degree - Undergraduate

Nassau Community College

High School Diploma - undefined

Floral Park Memorial High School

Skills

Operational Analysis: Expert in Excel (pivot tables, custom tracking, and formulas), revenue cycle data organization, and process optimization
Claim Coordination: Proficient in identifying documentation gaps for No Fault, Workers' Comp (Section 32), and Personal Injury Liens; skilled in securing critical denials and ledgers for management review
Workflow Development: Experience building training modules and Standard Operating Procedures (SOPs) to standardize department wide task handling and data entry

Communication & Mediation: Bilingual (English/Spanish); expert in mediating between clinical staff and law firms to resolve outstanding case requirements and facilitate settlements
Technical Proficiency: Advanced Excel, EMR/EHR Systems (including data integrity audits), and strict adherence to HIPAA compliance

Languages

Spanish

Professional Working

Timeline