Summary
Overview
Work History
Education
Skills
Timeline
Generic

ELIZA MARIA PEDROZA

Rochester,NY

Summary

Professional billing expert with proven track record in financial accuracy and efficiency. Skilled in managing invoicing, reconciliations, and payment processing with focus on compliance and timeliness. Strong collaborative abilities and adaptability ensure effective teamwork and optimal results. Known for reliability, adaptability, and results-driven approach.

Overview

7
7
years of professional experience

Work History

Senior Account Representative

U of R
03.2024 - Current
  • Follow up on unpaid accounts (check claim status on the appropriate payer system or contact insurance representative to obtain information as to why the claim is not paid and the necessary steps fro the process
  • Initiate collection phone calls to insurance companies to determine reason for claim denial.
  • Kept all patient information secure and confidential.
  • Identified, researched, and resolved billing variances to maintain system accuracy and currency.
  • Provided exceptional customer service in handling billing inquiries, resolving disputes promptly and professionally.
  • Conducted regular audits of billing records, identifying issues and implementing corrective actions.
  • Followed up with appropriate parties to obtain prompt payments.
  • Managed a high volume of invoices, prioritizing workload to meet deadlines and maintain cash flow.
  • Generated detailed reports for management review, highlighting trends and potential areas for improvement and resolving billing issues on claims. For examples: 2nd level report,medicaid report,over 10k or 40k reports,credits balances, under 30 days
  • Increased revenue through timely processing of invoices and thorough follow-up on outstanding payments.
  • Worked with multiple departments to check proper billing information.

Account Representative

U of R
02.2023 - 03.2024
  • Follow up on unpaid accounts (check claim status on the appropriate payer system or contact insurance representative to obtain information as to why the claim is not paid and the necessary steps for the process
  • Initiate collection phone calls to insurance companies to determine reason for claim denial.
  • Research and calculate under or overpaid claims to determine final resolution. Including following up with payers on incorrectly paid claims through final resolutions and adjudication.
  • Work weekly, bi-weekly and monthly reports and work list. examples: 2nd level report, Medicaid report, over 10k or 40k reports.
  • Identify patterns and clarifying issue from payers account that required
    management interventions
  • Coordinate with other departments within U of R to get claim issues resolved and completed to be paid properly.

Access Associate (Oral Surgery)

Rochester Regional Hospital, Reidman Health Center
03.2022 - 01.2023
  • Ensure that all providers' schedules are full
  • Once pre-determination is received it is an AA's responsibility to contact the patient and schedule them with the appropriate provider
  • Answering inbound telephone calls from Genesys and backline's
  • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
  • Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
  • Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
  • Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
  • Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
  • Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
  • Facilitated communication between patients and various departments and staff.
  • Helped address client complaints through timely corrective actions and appropriate referrals.
  • Responding to telephone encounters, scheduling patients provided to you by the Providers
  • Pre-Registration (7 days prior and 24 hours prior for any added patients)
  • Ensuring that all insurances are verified for all appointments
  • Print labels and forms for upcoming appointments
  • Informing patients of account balances and due amounts prior to the time of visits
  • Collect and received incoming referrals from providers
  • Schedule ED follow ups from patients seen at RGH hospitals with providers on call that day.

Access Associate (Dental)

Rochester Regional Hospital, Reidman Health Center
01.2021 - 03.2022
  • Greeting patients, performing check-in and check-out procedures and processing payments
  • Ensure that all providers' schedules are full
  • Once pre-determination is received it is the AA's responsibility to contact the patient and schedule them with the appropriate provider
  • Answering inbound telephone calls from Genesys and backline's
  • Responding to telephone encounters, scheduling patients provided to you by the Providers
  • Pre-Registration (7 days prior and 24 hours prior for any added patients)
  • Ensuring that all insurances are verified for all appointments
  • Receive consult information and inform Providers once sent from the hospital
  • Print labels and forms for upcoming apts
  • (Oral surgery/ Urgent care)
  • Informing patients of account balances and due amounts prior to the time of visits.
  • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
  • Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
  • Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
  • Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
  • Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
  • Followed document protocols to safeguard confidentiality of patient records.
  • Facilitated communication between patients and various departments and staff.

Clerk/Typist

NJ Department Of Labor
05.2018 - 11.2020
  • Respond to emails in a timely manner
  • Mail appeal status information to employer and claimant
  • Mail appeal Tribunal decisions daily
  • Handling incoming calls from claimants, employers, and other parties
  • Process incoming mail, faxes and emails on a daily
  • Giving customer status updates on claims
  • Translate incoming mail from Spanish to English
  • Variety of file management duties including scanning, processing, faxing and filing documents
  • Entering client information into the appeal system.
  • Reviewed records, paperwork and orders for errors and resolved issues with minimal direction.
  • Accepted dictated notes and produced professional documents with outlined information.
  • Attended training associated with role to improve skills and boost speed.
  • Wrote and mailed letters outlining requested information and denials or approvals.
  • Answered and routed incoming calls and took messages when personnel were unavailable.
  • Checked completed work for proper spelling, grammar, punctuation and format.
  • Interacted with public on phone and at reception desk to answer questions and resolve issues.
  • Entered data into databases in alphabetic and numerical order.
  • Prepared data by compiling and sorting information.
  • Verified data entered into database by reviewing, correcting and deleting data.

Education

Associate of Arts - Fine Arts

Mercer County Community College
Trenton, NJ
03.2025

High School Diploma -

Ewing High School
01.2017

Skills

  • Communicating policy guidelines
  • Service excellence
  • Insurance information retrieval
  • Billing accuracy assurance
  • Effective multitasking
  • Customer service excellence
  • Maintains focus in high-stress situations
  • Information documentation
  • Thorough investigative research
  • Efficient time management
  • Detail-oriented approach
  • Professional communication skills

Timeline

Senior Account Representative

U of R
03.2024 - Current

Account Representative

U of R
02.2023 - 03.2024

Access Associate (Oral Surgery)

Rochester Regional Hospital, Reidman Health Center
03.2022 - 01.2023

Access Associate (Dental)

Rochester Regional Hospital, Reidman Health Center
01.2021 - 03.2022

Clerk/Typist

NJ Department Of Labor
05.2018 - 11.2020

Associate of Arts - Fine Arts

Mercer County Community College

High School Diploma -

Ewing High School

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