Estefania Rosario Nin
Lancaster,OH
Summary
Appeals Coordinator at Quantum Health with a proven track record in streamlining processes and enhancing efficiency. Skilled in policy interpretation and HIPAA compliance, I excel in problem-solving and fostering teamwork. My commitment to confidentiality and effective communication has led to successful resolutions of complex member issues.
Overview
9
9
years of professional experience
Work History
Appeals Coordinator
Quantum Health
Dublin, OH
02.2025 - Current
- Coordinated appeals processes.
- Reviewed and analyzed appeal cases for compliance with regulatory requirements.
- Collaborated with cross-functional teams to resolve complex member issues effectively.
- Managed documentation of appeal outcomes, maintaining accurate records.
- Organized and managed appeals caseloads, prioritizing high-priority cases for timely resolution.
- Implemented streamlined appeals process, utilizing custom resources to drive efficiency improvements.
- Ensured confidentiality of sensitive information by following HIPPA throughout the appeals process.
- Developed strong working relationships with my team fostering a collaborative environment for efficient resolution of appeals.
Bilingual Customer Service Representative
Quantum Health
Dublin, OH
01.2023 - 08.2024
- Provided bilingual support to customers, resolving inquiries efficiently and professionally.
- Assisted in training new staff on customer service protocols and language-specific communication techniques.
- Actively listened to customers, handled concerns quickly and escalated major issues to Pod leadership.
- Enhanced customer satisfaction by addressing and resolving complex inquiries in both English and Spanish languages.
Psychiatry Intern
Hospital Dr. Francisco Moscoso Puello - Santo Domingo
Santo Domingo, Dominican Republic
01.2017 - 04.2017
- Coordinated appeals processes.
- Reviewed and analyzed appeal cases for compliance with regulatory requirements.
- Collaborated with cross-functional teams to resolve complex member issues effectively.
- Managed documentation of appeal outcomes, maintaining accurate records.
- Organized and managed appeals caseloads, prioritizing high-priority cases for timely resolution.
- Implemented streamlined appeals process, utilizing custom resources to drive efficiency improvements.
- Ensured confidentiality of sensitive information by following HIPPA throughout the appeals process.
- Developed strong working relationships with my team fostering a collaborative environment for efficient resolution of appeals.
Customer Service Representative
Quantum Health
Dublin, OH
07.2021 - 12.2022
- Assisted customers with inquiries, providing accurate information and resolving issues.
- Resolved escalated issues, demonstrating strong problem-solving skills and commitment to satisfaction.
- Assisted customers with inquiries, providing accurate information and resolving issues efficiently.
- Managed customer accounts, ensuring timely updates and maintaining data integrity in systems.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
Primary Care Intern
Servicio Regional De Salud Metropolitano - Santo Domingo
Santo Domingo, Dominican Republic
09.2017 - 12.2017
- Assisted in data collection and analysis for public health initiatives.
- Supported administrative tasks, ensuring smooth daily operations and communication.
- Participated in community outreach programs to promote health awareness.
- Organized and maintained health records with attention to confidentiality and accuracy.
Internal Medicine Intern
Hospital Padre Billini - Santo Domingo
Santo Domingo, Dominican Republic
09.2017 - 12.2017
- Conducted patient assessments and documented medical histories to support diagnosis and treatment planning.
- Assisted in performing routine examinations, including vital signs and lab tests, ensuring accurate data collection.
- Collaborated with healthcare team to develop individualized care plans tailored to patient needs and conditions.
- Supported senior physicians during procedures, enhancing skills in clinical techniques and patient management.
Obstetrics and Gynecology Intern
Hospital De La Mujer Dominicana - Santo Domingo
Santo Domingo, Dominican Republic
05.2017 - 08.2017
- Assisted in patient intake processes to ensure accurate information collection.
- Supported healthcare professionals by preparing medical equipment and supplies for procedures.
- Maintained cleanliness and organization of clinical areas to promote a safe environment.
- Observed patient interactions to learn effective communication strategies within healthcare settings.
General Surgery Intern
Hospital Gral. Plaza De La Salud - Santo Domingo
Santo Domingo, Dominican Republic
01.2017 - 04.2017
- Assisted healthcare professionals with patient care tasks and routine procedures.
- Supported documentation processes by accurately entering patient information into electronic health records.
- Collaborated with team members to ensure compliance with safety protocols in clinical settings.
- Observed and learned various medical practices, enhancing understanding of hospital operations.
Education
Doctor in Medicine -
Universidad Iberoamericana UNIBE
Santo Domingo, Dominican Republic2018
Skills
- Data entry proficiency
- Policy interpretation
- Confidentiality
- Insurance regulations
- HIPAA compliance
- Effective communication
- Medical terminology
- Insurance policies
- Customer service
- Problem-solving
- Teamwork and collaboration
- Attention to detail
- Critical thinking
- Organizational skills
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
Appeals Coordinator
Quantum Health
02.2025 - Current
Bilingual Customer Service Representative
Quantum Health
01.2023 - 08.2024
Customer Service Representative
Quantum Health
07.2021 - 12.2022
Primary Care Intern
Servicio Regional De Salud Metropolitano - Santo Domingo
09.2017 - 12.2017
Internal Medicine Intern
Hospital Padre Billini - Santo Domingo
09.2017 - 12.2017
Obstetrics and Gynecology Intern
Hospital De La Mujer Dominicana - Santo Domingo
05.2017 - 08.2017
Psychiatry Intern
Hospital Dr. Francisco Moscoso Puello - Santo Domingo
01.2017 - 04.2017
General Surgery Intern
Hospital Gral. Plaza De La Salud - Santo Domingo
01.2017 - 04.2017
Doctor in Medicine -
Universidad Iberoamericana UNIBE