Idalia Rebolloso
Pharr
Summary
Dynamic and results-oriented professional with extensive experience at the Office of Injured Employee Counsel. Proven expertise in claims processing and dispute resolution, complemented by strong communication and problem-solving skills. Adept at fostering teamwork and maintaining positive relationships, ensuring efficient operations and timely resolution of complex issues in fast-paced environments.
Dynamic individual with hands-on experience in workers compensation and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Ombudsman IV
Office of Injured Employee Counsel
05.2016 - Current
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments. Observes all applicable agency policies and procedures, including adhering to established leave and attendance policies, safety rules and regulations, travel procedures, and use of state property.
- Functions as a technical expert in claims processing and procedures and works with staff to develop and update procedures, practices, and policies for publication on the agency's on-line technical and administrative manual or issues.
- Skilled at working independently and collaboratively in a team environment.
- Managed time efficiently in order to complete all tasks within deadlines.
- Proven ability to learn quickly and adapt to new situations.
- Developed and maintained courteous and effective working relationships.
- Excellent communication skills, both verbal and written.
- Proved successful working within tight deadlines and a fast-paced environment.
- Worked well in a team setting, providing support and guidance. Exhibits key competencies necessary to role including flexibility in dealing with adverse and demanding situations, conducting independent studies, developing, and maintaining knowledge of workers' compensation laws, rules, Appeals Panel decisions, medical terminology, and other relevant subject matter
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Assists in resolving disputes throughout the administrative law process; properly organizes documentation and records information on contacts and case action; advises and explains relevant state and federal rules, regulations, and procedures, such as those relating to workers' compensation, employment rehabilitation, return to work, or other specific topics.
- Performs highly technical consultations on issues and procedures concerning Pre-Hearing/Benefits Review Conferences, Contested Case Hearings, arbitration proceedings; facilitates information flow between various parties involved in a dispute; may train or lead others.
- Meets with unrepresented claimants, a private meeting prior to the informal or formal hearing,and with employers and other participants to help prepare for Pre-Hearing/Benefit Review Conferences, Contested Case Hearings, appeals to Appeals Panel, arbitration proceedings and proceedings under the Administrative Procedures Act.
- Communicates, meets with, and provides information and assistance to injured workers,employers, insurance carriers, health care providers and other participants.
- Investigates complaints concerning workers' compensation matters; may participate in public speaking.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Workers Compensation Medical Billing Specialist
Doctors Hospital at Renaissance Health System
03.2008 - 05.2016
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Located errors and promptly refiled rejected claims.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Identified and resolved patient billing and payment issues.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Maintained strong working relationships with healthcare providers, fostering clear communication regarding billing-related matters.
- Managed patient accounts effectively, resolving discrepancies and addressing outstanding balances in a timely manner.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked flexible hours across night, weekend, and holiday shifts.
- Managed time efficiently in order to complete all tasks within deadlines.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Learned and adapted quickly to new technology and software applications.
- Strengthened communication skills through regular interactions with others.
- Collaborated with insurance companies to resolve claim discrepancies.
- Coordinated with healthcare providers to gather necessary documentation for claims.
- Reduced errors in billing statements by conducting thorough audits.
- Verified insurance eligibility for ensuring accurate billing.
Medical Billing Specialist
Dr. Marcos J. Valdez
04.2003 - 03.2008
- Posted and adjusted payments from insurance companies.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Located errors and promptly refiled rejected claims.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Identified and resolved patient billing and payment issues.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
Education
No Degree - Medical Certificate
South Texas Vo Tech
McAllen, TX05-1996
High School Diploma -
Hidalgo High School
Hidalgo Texas 05-1995
Skills
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Flexible and adaptable
- Dependable and responsible
- Multitasking
- Excellent communication
- Critical thinking
- Computer skills
- Organizational skills
- Active listening
- Organization and time management
Languages
Spanish
Native or Bilingual
Certification
- Workers Compensation Adjuster License
Timeline
Ombudsman IV
Office of Injured Employee Counsel
05.2016 - Current
Workers Compensation Medical Billing Specialist
Doctors Hospital at Renaissance Health System
03.2008 - 05.2016
Medical Billing Specialist
Dr. Marcos J. Valdez
04.2003 - 03.2008
No Degree - Medical Certificate
South Texas Vo Tech
High School Diploma -
Hidalgo High School
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