Ingrid Caminero

Negotiated claim rates with various commercial insurances, such as UHC and BCBS.

• Collected on aged accounts over 180 days by following up with respective insurance companies.
• Analyzed denial codes from health insurance EOBs and EOPs to guide fee schedule assessments.
• Ensured medical necessity through thorough reviews of denials, enabling successful re-appeals.
• Executed daily transaction balancing, focusing on payment data entry and pending claims reconciliation.
• Demonstrated understanding of regulations, forms, and insurance practices impacting healthcare providers.
• Applied medical coding knowledge, utilizing ICD-9 and CPT standards for accurate billing processes.

• Entered demographic data, disease history, diagnostic procedures, and treatment details into database.
  Managed medical records department, supervising clerical staff to enhance operational efficiency.
  Compiled and maintained patient medical records to document conditions and treatments for research purposes.
  Prepared statistical and narrative reports, including graphic presentations of tumor registry data for various stakeholders.

• Executed insurance benefit verification for all payers to uphold plan requirements.
• Secured necessary authorizations in alignment with plan benefits.
• Managed efficient processing of incoming correspondence from payors.
• Addressed coverage issues and escalated complex cases to Supervisor as needed.
• Maintained accuracy and timeliness in processing benefit information.
• Generated monthly invoices for nursing home room and board obligations.

Negotiated hospital and ancillary claim rates with commercial insurers, including Harvard Pilgrim and BCBS.

• Followed up on aged accounts exceeding 180 days to ensure timely collections.
• Reviewed denial codes on EOBs and EOPs to determine fee schedule rates.
• Analyzed medical necessity documentation to successfully overturn denials and re-appeal claims.
• Performed data entry for payments and adjustments, ensuring accurate daily transaction balancing.
• Maintained knowledge of insurance regulations, forms, and practices impacting healthcare providers.
• Applied expertise in ICD-9 and CPT coding to support claims processing.