Dannie Di Tillio-Gonzalez
Oak Park,IL
Summary
Smart decision-maker and insurance professional promoting 7+ years of highly knowledgeable and committed to improving policies and procedures in healthcare service and insurance companies. Hardworking and creative, with a quality-focused and proactive approach, managing and problem-solving abilities. Bringing impassioned experience in insurance compliance, claim and benefit to any demanding work environment.
Overview
17
17
years of professional experience
Work History
Clinical Service Representative
Anthem Elevance Health
06.2021 - 06.2023
- Assisted patients, providers, health advocates, billing companies, etc., with insurance consultation on eligibility, benefits, claims, authorizations, copays, coinsurance, deductibles.
- Claim review and decision-making to resubmission, reprocessing, or appeal. Verified information by analyzing evidence on file. Provider resources and network status.
- Researched compliance with Federal/ States regulations, Department guidelines and Client policies. Updated patient's account. Created/sent correspondence, billing, appeals.
- Applied HIPPA for confidentiality. Verified patient's account registration. Made contact with insurance carriers to discuss policies, benefits and claims.
Health Care Representative
CVS HEALTH CORPORATION
05.2020 - 05.2021
- Managed prescription's health insurance inquiries, Medicare, Medicaid (LIS) coverage. Research data on claims and appeals status, benefits, finance, and payment history.
- Guided customers on retail/mail-orders, prescription refills, formulary drugs and tiers, label and shipping, statements, claim forms, and ID cards.
- Resolved conflicts and initiated corrective action on consents, determinations, claims, appeals, exemptions, alternative medications, reversal, and prescription transfers.
- Submitted complaints. Reviewed status of balances. Operated a PC/image station to search database, Windows, Microsoft, Excel, company webpage.
Insurance Processor
Loan Protector Insurance Services
04.2018 - 04.2020
- Analyzed proof of insurance and billing. Created and updated loan accounts following regulatory requirements, created/logged documents.
- Processed eligibility, benefits and authorization requests. Processed payment in system, initiation of billing process and cancellations. Initiated Claims for policies.
- Educated customers about standard procedures for all policies, and timeframe for submission of documents and requirements.
- Evaluated quality assurance and reported evaluations through central automated system.
Insurance Specialist
Progressive Insurance
03.2017 - 03.2018
- Processed mathematical calculations to assist with coverage, billing information, claims, insurance quotes, payments, policy renewals, reinstatements, cancellations, underwriting and changes to policy.
- Ensured all procedures and policies are completed.
- Handled four different systems with initiative and organized noting of information in the system. Oversaw via email and fax certificates of insurance, endorsement, receipts, claim history/loss runs.
Client Account Representative
Safeguard Properties
02.2013 - 02.2017
- Thoroughly reviewed, open and updated Bank accounts according to FDA and loan type regulations.
- Analyzed accounts for delinquencies. Submitted bids, approved and/or followed up for approval.
- Extensively reviewed FHA, VA, CA, Freddie Mac and Fannie Mae loans in accordance with Quality Control for Bank of America and over twenty plus Clients.
- Interviewed vendors to authorize or deny services to properties in default.
- Managed daily productivity report for the Team. Collaborated with projects for bids to investors, completion and compliance with HUD requirements.
Research Associate
Case Western Reserve University
01.2010 - 12.2012
- Effectively reviewed research protocols submitted to the Institutional Review Board (IRB) for Clinical Research for approval. Verified accuracy of advanced directives, patient's informed consent, health insurance, and certified submissions with required documentation.
- Communicated with research coordinators about submission process, completeness, and deadlines, compliance with regulations and guidelines.
- Managed electronic records for research protocols in the IRB office through patient health information databases (PHI). Gathered, arranged and corrected research data. Problem-solved, quality and general operational improvements to the IRB based on audit.
Fellow
Columbia University, Department Of Bioethics
01.2006 - 01.2010
- Analyzed regulations for biomedical/clinical research applied in Institutional Review Boards and Ethics Committees at hospitals, as well as reviewed research protocols, customers patients informed consent for compliance.. Contributed to research activities.
- Interviewed patients for consent to participate in clinical research. Advised and educated patient's medical decision-making process.
- Prepared, presented and published original research data and reports for research proposals for grant submission and publications. Presented talks and seminars within the Department monthly seminars and round tables. Analyzed data for further research.
- Developed unique research into in International Bioethics.
Education
MA Bioethics -
Case Western Reserve University
Cleveland, OH2010
LLM - Business Law
University of Greenwich
Greenwich, England2001
LLB - Business Laws And Legislation
Los Andes University
Merida, Venezuela1998
Skills
- Claims Analysis
- Software Navigation
- Project Management
- Analytical Skills
- Confidentiality
- Investigation Techniques
- Policy Interpretation
- Auditing Processes
- Insurance Claim Forms Review
- Claim Amount Calculations
- Records Management
- Prior Authorization Processing
- Information Verification
- Insurance Coverage Verification
Accomplishments
- ANTHEM ANNUAL INCREASE AWARD, “For achieving high performance results aligned with insurance objectives and efficient customer care” Anthem, New York, 2022.
- CVS HEALTH ANNUAL MERIT INCREASE REWARD. "For achieving high performance results aligned with insurance coverage objectives”, 2020, CVS Health/Caremark
- TOP TEN MOST PRODUCTIVE EMPLOYEE IN DEPARTMENT, 2018, Loan Protector, Solon, OH
- MOST PRODUCTIVE EMPLOYEE IN DEPARTMENT, 2013, Safeguard Properties
- RESEARCH AWARD OF THE YEAR, 2008, University of Los Andes.
- NIH Award Fellowship Fogarty International Center, 2006
Languages
Spanish
Native or Bilingual
Timeline
Clinical Service Representative
Anthem Elevance Health
06.2021 - 06.2023
Health Care Representative
CVS HEALTH CORPORATION
05.2020 - 05.2021
Insurance Processor
Loan Protector Insurance Services
04.2018 - 04.2020
Insurance Specialist
Progressive Insurance
03.2017 - 03.2018
Client Account Representative
Safeguard Properties
02.2013 - 02.2017
Research Associate
Case Western Reserve University
01.2010 - 12.2012
Fellow
Columbia University, Department Of Bioethics
01.2006 - 01.2010
MA Bioethics -
Case Western Reserve University
LLM - Business Law
University of Greenwich
LLB - Business Laws And Legislation
Los Andes University
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