Gabriela Beltran

Inbound call handling,Providing customer service using approved script.

Resolving patient accounts and accurately documenting

Update patient account in accordance to client

Resolves all patients inquiries to solution the outstanding balances

Submit follow up request to third party units

Follow payer contracts, rules and regulation

Insurance billing priority

Review claim denials, rejections and underpayments

Manage various types of payments(lockboxes,e-bill and wires/ach)

Accurate and efficient check tracing

Identified one payment to be split in several invoices

Request refunds

Request refund of any.

Coordination of benefits

Update insurance information to patient account and rebill.

• Responsible for sending correspondence letters to Members to acknowledge:
• Sent correspondence to CMS
• Appointment setter for transportation
• Requested ID cards for Members
• Appeals and grievances
• Answered Member inquiries on benefits, eligibility, referrals, claims
• Insurance eligibility (HMO, PPO, Medi-Cal, Medicare)
• Answered questions of pharmacy inquiries for Members
• Answered a high volume of inbound calls, transfer calls to appropriate staff
• Made outbound calls regularly
• Assisted Members with technical issues including website and escalate issues to management
• Researched billing issues and processed payment for premiums and misapplied payments
• Maintained confidentiality of all patient information and provided excellent customer service
• Audit Member Service Reps

• Review claims for any discrepancy that has delay payment to claimant
• Process correct claims and post payments to accounts
• Verify identity of claimants
• Verify eligibility
• Escalate any fraud activities to the Fraud department
• Maintain frequent telephone contact with management and supervisor from client companies, gathering facts necessary to determine if unemployment claims are disputable and explaining unemployment rules, regulations, decisions, and options

• Answered Member inquiries on benefits, eligibility, referrals, claims
• Obtain feedback on services and provide feedback to the company
• Contact members to follow up on referrals and assist setting up appointments
• Assist members with inquires of obtaining additional referrals
• Verifying members are being referred to the proper counselor for their needs
• Verifying eligibility of members plan
• Verifying eligibility on Company terms
• Verifying email address for survey follow up purposes
• Follow- up with case management for single case agreement to be process on timely manner

• Managed different provider authorizations for Concerto members and audited CPT/HCPCS codes to ensure timely authorizations
• Approved CPT items for members and created authorizations
• Requested clinical documentations and worked with clinical department to ensure that all information is sufficient for decision
• Cross trained to perform on all aspects of the utilization management cycle to receive authorizations, mail, and call members to notify them on their status and manage customer service calls

• Responsible for sending correspondence letters to Members to acknowledge:
• Sent correspondence to CMS
• Appointment setter for transportation
• Requested ID cards for Members
• Appeals and grievances
• Answered Member inquiries on benefits, eligibility, referrals, claims
• Insurance eligibility (HMO, PPO, Medi-Cal, Medicare)
• Answered questions of pharmacy inquiries for Members
• Answered a high volume of inbound calls, transfer calls to appropriate staff
• Made outbound calls regularly
• Assisted Members with technical issues including website and escalate issues to management
• Researched billing issues and processed payment for premiums and misapplied payments
• Maintained confidentiality of all patient information and provided excellent customer service

• Responsible for sending correspondence letters for collections
• Prepared and reviewed clean claims for submission to various insurances electronically and paper
• Edited and submitted claims for payment
• Evaluated and secured the needed RX's PA's and medical justification to facilitate payment of claims for initial and review/appeals payments
• Denial management
• Medical terminology, HCPC, ICD codes, government, commercial, managed care payor’s
• ICD
• National Electronic Attachments Program, ERP 2.01, Zirmed, Artivia, HCPC, ICD