Edangely Marte
Reimbursement Specialist
Ridgefield,NJ
Summary
Experienced Reimbursement Specialist with solid background proactively managing claims and preventing insurance issues. Proficient in keeping records accurate and current and proactively managing account problems. Excellent customer relations skills combined with analytical approach to handling routine and complex delays. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
Overview
19
19
years of professional experience
Work History
Manager / Reimbursement Specialist
Metropolitan Dermatology
05.2019 - Current
- Regularly resolved physician payment issues with expediency.
- Assisted in group credentialing and contracting by sending linkage letters and updating pay to addresses with all health plans for over 39 Physicians and 26 PAs.
- Accustomed to providing assistance to Physicians and Physician assistants with reimbursement issues.
- Experience with eligibility verification utilizing Navinet and Availity as well as other payer portals.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Trained managers and others on new payment processing platforms.
- Website portal enrollment and setup for office staff; Navinet, Change Healthcare, Humana, Instamed, Echo, Zelis, Payspan, Availity, Emblem, Papaya, Health partners, Palmetto, and others.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Monitored and documented accounts receivable trends and account-specific profitability.
- Trained department employees in proper billing and accounting procedures.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
- Helped minimize escalations by reaching out to clients in advance of expected problems.
- Contributed knowledge to help improve financial management, billing and tracking systems.
- Audited and corrected billing and posting documents for accuracy.
- Monitored outstanding invoices and performed collections duties.
- Utilized various software programs to process customer payments.
- Generated monthly billing and posting reports for management review.
- Generated accounts payable reports for management review to aid in financial and business decision making.
Medical Coder -Biller /Administrator Assistant
Empire Billing Services, Corp
01.2005 - 05.2019
- Carefully reviewed medical records for accuracy and completion as required by insurance companies
- Accurately entered procedure codes, diagnosis codes and patient information into billing software
- Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature
- Consistently ensured proper coding, sequencing of diagnoses and procedures
- Quickly responded to staff and client inquiries regarding CPT codes
- Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information
- Strictly followed all federal and state guidelines for release of information
- Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative
- Thoroughly reviewed remittance codes from EOBS/ERAS, evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature
- Completed appeals and filed and submitted claims
- Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house
- Meticulously tracked and resolved underpayments
- Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
Education
Associate - Health Service Administration
Berkeley College
Woodland Park, NJ2021
Science
Borough of Manhattan Community College of The City University of New York
New York, NY2008
Pre-Med - Medicine (Pre-Medicine)
PUCMM
Santiago De Los Caballeros, Dominican Republic2004
Skills
- Insurance Credentialing
- Insurance EFT Enrollment
- Practice Management
- Quality Assessment
- Communication
- Problem-Solving
- Healthcare Terminology
- Reimbursement Management
- Policy Evaluation
- Strategic Initiatives
- Microsoft Office
- 10-Key Data Entry
- Discrepancy Reconciliation
Languages
Spanish
Native or Bilingual
Timeline
Manager / Reimbursement Specialist
Metropolitan Dermatology
05.2019 - Current
Medical Coder -Biller /Administrator Assistant
Empire Billing Services, Corp
01.2005 - 05.2019
Associate - Health Service Administration
Berkeley College
Science
Borough of Manhattan Community College of The City University of New York
Pre-Med - Medicine (Pre-Medicine)
PUCMM
Similar Profiles
Jessica Troya-PenaJessica Troya-Pena
Medical Assistant at Metropolitan DermatologyMedical Assistant at Metropolitan Dermatology
Maritza X. OquendoMaritza X. Oquendo
Medical Assistant at Metropolitan DermatologyMedical Assistant at Metropolitan Dermatology
Brittany HollandBrittany Holland
Medical Assitant at Metropolitan DermatologyMedical Assitant at Metropolitan Dermatology