Jeanette Rodriguez
Hopewell Junction
Summary
Experienced healthcare reimbursement and coordination of benefits (COB) professional with extensive background in Medicare Secondary Payer (MSP) regulations, CMS processes and revenue cycle operations. Skilled in researching complex claim issues, reviewing payer requirements and supporting accurate reimbursement outcomes across multiple insurance lines. Strong knowledge of Medicare, commercial insurance, workers compensation, no-fault, and third-party liability processes. CPC-A and CRCR certified with experience utilizing multiple revenue cycle and claims management systems.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Patient Financial Reimbursement Specialist III
Northwell Health (formerly Nuvance Health)
02.2020 - Current
- Review and analyze pre-payment insurance claims to ensure accurate reimbursement outcomes.
- Research claim status, payer requirements, authorizations, and billing issues across multiple payers.
- Utilized Cerner, Soarian Financials, FinThrive, and Visiquate to assess claim activity and reimbursement workflows.
- Support resolution of complex billing issues through detailed account reviews and collaboration with internal teams.
- Maintain compliance with payer guidelines, hospital billing requirements, and regulatory standards.
- Assist leadership with workflow support, staff guidance, and process improvement initiatives.
- Monitor work queues to ensure timely follow-up on pending claims and reimbursement accounts.
Senior Kitchen Worker
Arlington Central School District
09.2012 - 02.2020
Sales Associate
The Children’s Place
11.2011 - 08.2013
Intake Specialist
Group Health Incorporated
08.2004 - 08.2007
- Sorted, distributed, and batched daily Common Working File (CWF) referral forms and responses to ensure timely processing
- Input referral cases and responses into case tracking and letter generation systems to maintain accurate records
- Processed Workers Compensation Medicare Set-Aside (WCMSA) proposal documentation for scanning and tracking to facilitate compliance
- Maintained organized and accurate documentation to support CMS-related workflow requirements
COB Customer Service Representative
Group Health Incorporated
04.2000 - 08.2004
- Communicated with attorneys, insurance carriers, providers, and members to resolve coordination of benefits and coverage-related issues
- Investigated and processed inquiries on Medicare Secondary Payer (MSP) regulations and CMS Data Match project requirements, ensuring accurate compliance and timely resolution
- Ensured compliance with CMS regulations and managed coordination of benefits procedures
- Reviewed questionnaires and coordinated correspondence with internal departments and external CMS contacts to facilitate effective communication and information exchange
- Researched and responded to auto no-fault, workers compensation, and third-party liability claims inquiries, providing clear guidance and support to stakeholders
Medical Claims Approver
Group Health Incorporated
12.1991 - 04.2000
- Executed medical claims data entry, ensuring accuracy in claim information for timely processing
- Processed HCFA-1500 and UB-92 medical claim forms with a focus on accuracy and compliance
- Transcribed written diagnoses and procedures into ICD-9 codes for compliance with industry standards
- Upheld productivity and quality benchmarks within medical claims operations to ensure effective service delivery
Education
Associate in Applied Science -
Kingsborough Community College
Brooklyn, NY06-1992
Skills
- Coordination of Benefits (COB)
- Medicare Secondary Payer (MSP)
- CMS Regulations & Compliance
- Claims Processing & Research
- Pre-Payment Claim Review
- Insurance Verification & Eligibility
- Reimbursement Review
- Third-Party Liability (TPL)
- Workers Compensation & No-Fault Claims
- Claim Status Research & Resolution
- Healthcare Compliance
- Revenue Cycle Operations
- Workflow Optimization
- Healthcare Systems
- Team Collaboration
Certification
- CPC-A, Certified Professional Coder Apprentice, AAPC, 12/25
- CRCR, Certified Revenue Cycle Representative, HFMA, 02/26
Systems Technical Skills
- Cerner
- Soarian Financials
- FinThrive
- VisiQuate
- Microsoft Excel
- Microsoft Teams
- Microsoft Office Suite
Timeline
Patient Financial Reimbursement Specialist III
Northwell Health (formerly Nuvance Health)
02.2020 - Current
Senior Kitchen Worker
Arlington Central School District
09.2012 - 02.2020
Sales Associate
The Children’s Place
11.2011 - 08.2013
Intake Specialist
Group Health Incorporated
08.2004 - 08.2007
COB Customer Service Representative
Group Health Incorporated
04.2000 - 08.2004
Medical Claims Approver
Group Health Incorporated
12.1991 - 04.2000
Associate in Applied Science -
Kingsborough Community College