Desiree Gonzalez
Cape Coral,FL
Summary
Lead Insurance Claims Specialist coordinating claim follow-up, denial resolution, and payer communication across a busy revenue cycle workflow. Manages 250 insurance claims weekly, including insurance claims, documentation checks, and escalation routing to keep accounts moving toward payment. Brings steady claims resolution support to front-end and back-end billing teams.
Overview
14
14
years of professional experience
Work History
Lead Insurance Claims Specialist
Lee Health
Cape Coral, FL
09.2024 - Current
- Process 250 insurance claims weekly while maintaining timely follow-up and documentation.
- Review claim details for completeness before submission to support cleaner processing and fewer follow-up requests.
- Coordinate denial resolution by identifying missing information, correcting claim issues, and tracking responses.
- Support appeals processing by organizing records, preparing documentation, and submitting supporting materials.
- Verify insurance coverage and eligibility information before service dates to reduce avoidable billing delays.
- Track outstanding claims and follow up with payers to move accounts toward resolution.
- Interpret explanation of benefits documents to confirm payment status and identify next steps for unresolved balances.
- Maintain accurate patient account records while coordinating updates across billing and revenue cycle workflows.
- Apply billing compliance guidelines when reviewing claims and supporting documentation for submission readiness.
- Coordinate prior authorization requests with supporting medical information to help prevent claim delays.
- Maintain HIPAA-compliant handling of patient and claim information throughout the review process.
- Assist with payment posting and balance updates to keep claim records current and organized.
- Validate charge capture details against submitted documentation to support accurate reimbursement handling.
- Interpret coding and claim form details to identify corrections needed before submission.
- Follow up on unpaid balances with clear communication and organized account notes.
Office Manager
Dr Ivan Mazzorana
Fort Myers, FL
10.2023 - 09.2024
- Verified patient insurance coverage and eligibility before visits to reduce billing delays.
- Reviewed claim denials and coordinated appeals documentation for resubmission.
- Supported revenue cycle activities by tracking patient balances and payment status.
- Maintained accurate billing records and updated account information for front office operations.
- Interpreted explanations of benefits to confirm payment application and outstanding balances.
- Prepared prior authorization requests and gathered supporting information for medical services.
- Tracked collections follow-up with patients while maintaining respectful and professional communication.
- Entered claim details and coding information accurately to support clean submission workflows.
- Coordinated daily office administration, including scheduling, records handling, and patient communication.
- Organized incoming correspondence and routed billing-related issues to the appropriate follow-up queue.
- Updated patient charts and supporting documents while protecting confidential information.
- Reviewed outstanding balances and prepared account summaries for internal follow-up.
- Assisted with patient intake workflows and collected required billing information at check-in.
- Monitored daily office tasks and resolved routine administrative issues for smooth operations.
Lead Medical Biller
Consultants Villar LLC
Fort Myers, FL
06.2016 - 10.2023
- Managed daily revenue cycle activities across claim submission, follow-up, and payment posting workflows.
- Reviewed denial letters and payer correspondence to identify corrections needed for resubmission and appeal preparation.
- Coordinated billing tasks with internal staff to keep patient account balances current and communication consistent.
- Maintained billing compliance practices while handling sensitive patient information and claim documentation.
- Prepared appeal packets with supporting documentation to address unpaid or underpaid claims.
- Verified coverage details and authorization requirements before services were billed to reduce rework.
- Interpreted EOBs to match payer adjustments, patient responsibility, and follow-up actions.
- Supported claim adjudication by reviewing coding, documentation, and submission details for completeness.
- Tracked collections follow-up tasks to keep unresolved balances moving through the billing queue.
- Reconciled payments against open claims and patient accounts to maintain accurate records.
- Monitored charge capture records and corrected missing documentation before final billing.
- Organized claim files and supporting records to streamline review and follow-up activities.
- Assisted with revenue cycle reporting by compiling billing updates and outstanding account statuses.
- Checked medical necessity review notes against claim requirements before submitting billing records.
Patient Access Specialists II
Lee Health System
Fort Myers, FL
03.2013 - 06.2016
- Processed 100 insurance verifications per day to support timely patient registration and account setup.
- Reviewed insurance coverage details and identified authorization requirements before scheduled patient services.
- Managed patient account questions and directed unresolved issues to the appropriate billing or support team.
- Prepared and submitted denial appeals with supporting documentation for payer review.
- Verified demographic and insurance details during patient registration to reduce account errors.
- Maintained accurate registration records while following HIPAA and billing compliance requirements.
- Updated payer records and account notes to support clear communication across billing workstreams.
- Coordinated with team members to balance daily front-end access tasks and address coverage gaps.
- Monitored eligibility issues and escalated complex cases for timely resolution.
- Verified insurance coverage and benefits for incoming patients before scheduled visits.
- Reviewed account details and corrected registration errors to support accurate billing workflows.
- Communicated authorization needs to clinical and billing teams to prevent avoidable claim delays.
- Escalated unresolved authorization and denial issues to appropriate departments for review.
- Maintained HIPAA-compliant handling of patient information during registration and billing interactions.
- Updated patient demographics and account information to keep records accurate across service encounters.
- Collected supporting documents for medical necessity review and prior authorization requests.
- Coordinated daily handoffs with team members to keep registrations and billing tasks moving.
- Supported collections follow-up by preparing patient account details for outreach and resolution.
Education
High School Diploma - undefined
Gateway Charter High School
Fort Myers, FL05-2007
Skills
- Claims adjudication
- Claim follow-up
- Denial resolution
- Appeals processing
- Insurance verification
- EOB interpretation
- Prior authorization
- Eligibility verification
- Denial management
- Appeals submission
- Revenue cycle management
- Medical billing
- Billing compliance
- Patient account resolution
- HIPAA compliance
- ICD-10 coding
- UB-04 claims
- Charge capture
- Payment posting
- Medical necessity review
- Collections follow-up
- Patient registration
- Eligibility determination
- Revenue cycle operations
- Patient account reconciliation
- Payer communication
- Claims follow-up
- Team coordination
- Workflow management
- Escalation management
Timeline
Lead Insurance Claims Specialist
Lee Health
09.2024 - Current
Office Manager
Dr Ivan Mazzorana
10.2023 - 09.2024
Lead Medical Biller
Consultants Villar LLC
06.2016 - 10.2023
Patient Access Specialists II
Lee Health System
03.2013 - 06.2016
High School Diploma - undefined
Gateway Charter High School