Jacquelin Cardenas
Houston,TX
Summary
Experienced healthcare professional with strong background in processing and managing medical claims. Skilled in analyzing complex data, ensuring compliance with regulations, and resolving claims efficiently. Known for collaborative approach and adaptability, consistently delivering results in dynamic environment.
Overview
10
10
years of professional experience
Work History
Patient Account Associate
Virtual BOA
05.2024 - Current
- Proven ability to learn quickly and adapt to new situations.
- Achieved timely reimbursements for clients through keen understanding of insurance company protocols.
- Managed high volume of claims, consistently meeting deadlines without compromising accuracy or quality.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Contributed to the overall financial stability of the healthcare facility by consistently meeting or exceeding billing and collection targets.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Expedited claim resolution times with diligent follow-ups on pending claims, collaborating closely with healthcare providers and insurance carriers.
- Responded to correspondence from insurance companies.
- Identified and resolved discrepancies between patient information and claims data.
Insurance Coordinator
The Rose Diagnostic Center
11.2015 - 05.2024
- Managed a high volume of inbound calls, promptly resolving issues while providing accurate information on policies and procedures.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Obtained prior authorization and precertification for outpatient procedures.
- Prepared insurance claims for submission to clearinghouses or insurance companies.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Calculated adjustments, premiums and refunds.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Responded to correspondence from insurance companies.
- Communicated with patients to resolve inquiries, schedule appointments, and address billing questions.
- Trained new team members on medical insurance coordination best practices, contributing to a highly skilled workforce within the department.
Education
High School Diploma -
Dobie High School
Houston, TX06-2013
Skills
- Teamwork and collaboration
- Denial management
- Claim submission
- CMS-1500, UB04 billing forms
- Bilingual English/Spanish
- Knowledgeable in Epic and Athena
- Knowledge of Managed Care, Commercial Insurances, Medicare, and Medicaid plans
Timeline
Patient Account Associate
Virtual BOA
05.2024 - Current
Insurance Coordinator
The Rose Diagnostic Center
11.2015 - 05.2024
High School Diploma -
Dobie High School
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