Daphne Cabral
Babylon
Summary
I am a dedicated and detail-oriented Insurance Follow-Up Representative with over seven years of experience in medical billing and revenue cycle management. After building a strong foundation as a Medical Billing Specialist at Heart and Health Medical, I now bring my expertise to RSIRCM, where I focus on resolving insurance denials, appealing underpaid claims, and ensuring timely reimbursement for providers and patients. I take pride in my ability to analyze complex claim issues, identify root causes, and implement effective solutions that improve accuracy and reduce delays in payment. I’m known for my strong problem-solving skills, thorough attention to detail, and commitment to maintaining compliance with payer policies and HIPAA regulations. Above all, I’m passionate about supporting my team and helping our organization achieve financial accuracy and outstanding patient care.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Insurance Follow-Up Representative
RSI
01.2025 - Current
- Analyzed insurance denials to identify trends, determine root causes, and recommend process improvements to reduce future rejections.
- Contacted third-party payers via phone, email, and payer portals to verify claim status, resolve denials, and ensure timely reimbursement.
- Reviewed and interpreted EOBs/ERAs to determine appropriate follow-up actions and appeal strategies.
- Prepared and submitted formal appeals, reconsiderations, and corrected claims in compliance with payer policies and deadlines.
- Investigated and resolved underpaid or rejected claims, collaborating with contract management and internal teams as needed.
- Monitored and maintained aging buckets to meet department KPIs for A/R days and follow-up turnaround times.
- Accurately documented all actions in workflow management systems and utilized internal tools such as crosswalks and tip sheets.
- Partnered with coding, registration, billing, and compliance teams to resolve root causes of denials and ensure clean claim submission.
- Supported onboarding and training of new team members with payer and system-specific guidance.
- Recommended and implemented process improvements based on payer behavior and denial patterns
Medical Billing Specialist
Heart and Health Medical
11.2017 - 01.2025
- Created and submitted accurate and complete medical claims to patients and insurance companies, emphasizing precision in billing procedures.
- Conducted thorough checks on patient insurance coverage and eligibility before initiating the billing process.
- Proactively followed up on unpaid claims and launched appeals for denied ones within standard billing cycle timeframes.
- Addressed patient inquiries regarding bills, provided clear explanations, and established payment plans for those unable to pay in full.
- Collaborated with medical coders and healthcare professionals to ensure precise billing and resolve discrepancies in a timely manner.
- Navigated and maintained electronic health records (EHR) and billing software, posting payments to patient accounts with diligence.
- Engaged with insurance companies to obtain updates on claim status and clarified billing details through effective communication.
- Adhered to HIPAA regulations, prioritizing patient confidentiality throughout all aspects of the billing process.
- Stayed informed on healthcare regulations, medical terminology, and coding practices to ensure up-to-date knowledge.
- Tracked, reviewed, and reported on billing metrics, trends, and conducted periodic audits to ensure compliance and accuracy.
Medical Billing Specialist/ Receptionist
ProHEALTH
04.2016 - 11.2017
- Arranged payment plans for overdue accounts, improving collection efficiency.
- Secured necessary referrals and authorizations, reducing procedural delays.
- Investigated and contested denied claims, enhancing claim approval rates.
- Addressed claim denials promptly, maintaining billing cycle standards.
- Welcomed office visitors, fostering a friendly and professional atmosphere.
- Meticulously tracked unpaid claims, adhering to standard billing cycles. Conducted thorough research to substantiate appeals, maximising successful outcomes.
Externship/ Medical Biller
Involution Medical
01.2016 - 04.2016
- Processed payments and addressed discrepancies, enhancing billing accuracy and patient satisfaction.
- Reviewed and resolved insurance denials, improving claim success rates and reducing outstanding balances.
- Communicated with insurers to correct account errors, ensuring accurate financial records.
- Assisted patients in understanding statements, fostering trust and clarity in billing processes.
- Streamlined patient and insurance payment posting, enhancing accuracy and efficiency in medical billing processes.
Education
High School Diploma -
Branford Hall Career Institute
Bohemia01.2016
High School Diploma -
Msgr. Scanlan High School
The Bronx, NY06.2009
Skills
- Analytical problem solving,
- HIPAA compliance
- Problem resolution
- Insurance verification
- Follow-up procedures
- Teamwork
Certification
- CERTIFIED ELECTRONIC HEALTH RECORD PROFESSIONAL (CEHRP) - American Medical Association
- BILLING AND CODING SPECIALIST CERTIFICATION (BCSC) - American Medical Certification Association
- MEDICAL ADMINISTRATIVE ASSISTANT CERTIFICATION (MAAC) - American Medical Association
Languages
Spanish
Native or Bilingual
Timeline
Insurance Follow-Up Representative
RSI
01.2025 - Current
Medical Billing Specialist
Heart and Health Medical
11.2017 - 01.2025
Medical Billing Specialist/ Receptionist
ProHEALTH
04.2016 - 11.2017
Externship/ Medical Biller
Involution Medical
01.2016 - 04.2016
High School Diploma -
Branford Hall Career Institute
High School Diploma -
Msgr. Scanlan High School