Juan Aguilar
Hammond,IN
Summary
Experienced and detail-oriented medical claims processor with a proven track record of accurately handling high volumes of medical claims, medical codes for(ICD-10, CPT, HCPCS), navigating complex insurance regulations to ensure timely reimbursement. Skilled in resolving claim discrepancies and maintaining strict compliance with HIPAA standards. Strong background in healthcare administration, medical interpreting, medical terminology, and case management. Well-equipped to contribute to the efficient operation of any healthcare organization.
Overview
10
10
years of professional experience
Work History
Claims Processor
LaSalle Network
04.2024 - 10.2024
- Processed medical PPO claims in a contracted position, for union members and their families, ensuring accuracy and compliance with industry standards
- Managed multiple queues, including claims for Medical Necessity, Durable Medical Equipment, Blue Cross & Blue Shield, Public Aid, EOB’s, and accident or illness claim requests
- Re-opened and resolved claims as necessary, demonstrating strong problem-solving skills, and attention to details
- Handled in the main queue 100 to 140 claims per day, maintaining efficiency and accuracy in a high-volume environment
Medical Interpreter
Sinai/Holy Cross Hospital
10.2022 - 01.2024
- Provided accurate and culturally sensitive interpretation services in (English and Spanish) for patients, doctors, pa's, nurses, medical students in all departments within the hospital
- Possessed a strong command of medical terminology in both English and Spanish to accurately convey complex medical information
- Demonstrated cultural competence in understanding and conveying healthcare practices, beliefs, with customers to ensure effective communication and patient care
- Provided interpretation services in various medical settings, primarily in the emergency room, but this also included other departments within the hospital such as: telemetry, podiatry, internal medicine, radiology, consultations, one day surgery, and other departments
- Completed daily reports of interpretation times by minutes, time, departments, & physician for management
Medical Biller
The Center for Sleep Medicine
03.2022 - 09.2022
- Completed daily billing for 10 different doctors and Physician Assistants using CMS 1500 Forms & other state forms when needed, draft appeals for claim denials to adhere to medical policies ensuring accuracy and compliance within industry standards
- Promoted to the billing authorization department to call, obtain daily pre-certifications for patient sleep studies, and doctor and physician assistant exams
- Provided customer service for Spanish speaking customers and assistance to account information and resolved questions for my team
- Utilized various platforms daily including: Availity, Aim, Humana, United Health and Blue Cross & Blue Shield
- Called companies directly when platforms did not verify insurance eligibility, and authorizations
- Took payments by phone, answering questions regarding deductibles, balances, verifying negotiated Blue Cross and Blue Shield rates for sleep machine and equipment
Case Manager
The Aliveness Project of NWI
05.2021 - 12.2021
- Managed a confidential caseload, counseling and transportation needs for 60+ patients with HIV
- Cross-trained (2) staff members in case management with processing and protocols, including: intake assessments, relationship management strategies, that correlated with organizational guidelines
- Coordinated with community agencies, doctors, hospitals, and clinics for updated labs and exam results for yearly updates for our files and consultations
- support healthcare, insurance referrals, and daily living needs for patients, to support client's emotional and physical wellbeing
- Composed regular 90-day wellness reviews for 60+ clients which half included Spanish speaking and required interpreting services to ensure quality care and service while maintaining quality audit standards in compliance with all state and federal regulations
Health Care Coordinator
Blue Cross Blue Shield
09.2019 - 10.2020
- Executed data entry and uploading of daily reports, including admissions, discharge, SASS referrals, and billing statements into Excel and company platform to ensure legal and regulatory compliance
- Directed the assignment of 30+ daily cases to 20+ care coordinators with online mapping tools and resources to ensure expeditious care and response measures aligned with the policyholder needs within a (2)hour radius
- Orchestrated care coordination and customer service for patients requiring assistance with medical decisions, insurance coordination, claims, benefits review, and service coordination
- Assisted the care coordinators with interpreting services for Spanish speaking clients
Claim Adjuster
Combined Insurance/Chubb
04.2015 - 03.2019
- Researched, reviewed medical bills and verified them on multiple platforms, in which our department handled sickness and accident claims, also interpreted for Spanish speaking clients throughout the U.S., ensuring that outcomes align with the Certification of each Insurance-policy
- Established proof of loss with physicians, hospitals, doctor offices and clinics to gather relevant information and resolve claim status
- Communicated with clients by phone or free form letters to educate on what is needed to process the claim
- Reconciled and recorded insurance determinations and benefit calculations with detailed accuracy utilizing extensive medical coding and tools including, ICD-9, ICD-10, HCPCS, and CPT codes
Education
Bachelor of Science - Business Management
St. Joseph’s College
Rensselaer, INMedical Billing Specialist Program - NHA: MCBC Certified
MedCerts
Livonia, MI(80)Hour Accredited Certificate - Medical Interpreting
The International Medical Interpreters Association
La Porte, INSkills
- Care Coordination
- Case Management
- Claims Processing
- Medical Billing and Coding
- Insurance Referrals and Verification
- HIPAA Compliance
- Medical Interpreting
- Federal Insurance Regulations
- Problem-solving
- Verbal & Written Communication in English and Spanish
- Insurance types understanding
- ICD-10-CM recognition
- CPT recogniti
- Resubmission process understanding
- Patient information gathering
- Patient documentation verification
- Reimbursement claims submission
- Healthcare provider payment optimization
Certification
Accredited Certificate for Medical Billing
Accredited Certificate for Medical Interpreting
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Full TimeWork Location
HybridOn-SiteRemoteImportant To Me
Work-life balanceCompany CultureHealthcare benefitsCareer advancementPaid time off401k matchPaid sick leaveWork from home optionPersonal development programsLanguages
Spanish
Full Professional
Interests
Reading, exercise, cooking, interested in learning another language
Accomplishments
Completed (8) years in the Army Reserve and National Guard, was honorably discharged as an E-5
Timeline
Claims Processor
LaSalle Network
04.2024 - 10.2024
Medical Interpreter
Sinai/Holy Cross Hospital
10.2022 - 01.2024
Medical Biller
The Center for Sleep Medicine
03.2022 - 09.2022
Case Manager
The Aliveness Project of NWI
05.2021 - 12.2021
Health Care Coordinator
Blue Cross Blue Shield
09.2019 - 10.2020
Claim Adjuster
Combined Insurance/Chubb
04.2015 - 03.2019
Bachelor of Science - Business Management
St. Joseph’s College
Medical Billing Specialist Program - NHA: MCBC Certified
MedCerts
(80)Hour Accredited Certificate - Medical Interpreting
The International Medical Interpreters Association
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