Juan C. Aguilar
Hammond,USA
Summary
Bilingual, Medical Claims Examiner with 10+ years' experience providing meticulous execution of healthcare administration, hospital and interpreting. Medical Claims processing, a proficient understanding in medical terminology and anatomy. Influential leader with a passion for providing detailed, relevant solutions that support individuals and team. Organizational efficacy recognized with progressive educational and professional achievements with hospital and global healthcare insurance. An Honorable discharge from the United States Army/ National Guard. Most recently completed a Med. Interpreting course in October of 2015, and a Med. Billing course in February of 2022.
Overview
10
10
years of professional experience
Work History
Claims Processor
LaSalle Network
Chicago, IL
04.2024 - 10.2024
- Processed medical PPO claims on a contracted position, for the members and their families, ensuring accuracy and compliance with industry standards
- Managed multiple queues, including claims for Letter of Medical Necessity, Durable Medical Equipment, accident letters, and SIOR illness
- Reopened and resolved claims as necessary demonstrating strong problem-solving skills and attention to detail
- Handled an average of 100 to 140 claims per day, maintaining efficiency and accuracy in a high-volume environment
Medical Interpreter
Sinai/Holy Cross Hospital
Chicago, IL
10.2022 - 01.2024
- Provided accurate and culturally sensitive interpretation services from (English and Spanish) for patients, nurses and healthcare professionals
- 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, and customers to ensure effective communication and patient care
- Provided interpretation services in various medical settings, including patient examinations, consultations, and all departments in the hospital
- Completed daily reports of interpretation times (minutes to monitor) for the dept, patient, and management
Medical Biller
The Center for Sleep Medicine
Orland Park, IL
03.2022 - 09.2022
- Completed daily billing, and worked super bills for 10 different doctors
- Promoted to the billing authorization department to call and obtain daily pre-certifications for patient sleep studies and other tests requested by doctors
- Provided customer service for Spanish speaking customers and assistance to account information
- Utilize various platforms daily including Availity, Aim, Humana, United Health and BCBS
- Called direct when platforms were unavailable to verify insurance eligibility, authorizations to complete daily requests
- In previous department took payments by phone and answered questions regarding balances and negotiated rates for sleep machine equipment, office visits and other services
Case Manager
The Aliveness Project of NWI
Hammond, IN
05.2021 - 12.2021
- Managed confidential case management, counseling, and transportation for 60+ patients with HIV
- Trained (2) new staff members in case management process and protocols, including intake, assessments, and relationship management strategies correlated with organizational guidelines
- Coordinated with community agencies, doctors, hospitals, and clinics to support healthcare, insurance referrals, and daily living needs for patients supporting their emotional and physical wellness
- 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
Caregiver
Hammond, IN
10.2020 - 05.2021
- Provided full-time health and general caregiving for an ill family member
Health Care Coordinator
Blue Cross Blue Shield
Chicago, IL
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
- 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
Professional Development
Chicago, IL
03.2019 - 09.2019
- Enhanced career development with research and review on medical career progression opportunities
Claims Adjuster
Combined Insurance
Chicago, IL
04.2015 - 03.2019
- Researched, reviewed medical bills on multiple platforms, analyzed sickness and accident claims and authorizations, handled claims, and interpreted for Spanish speaking clients throughout the U.S
- Ensuring outcomes align with the Certificate of Insurance-policy
- Paid for hospitalization, recovery, total disability, and other services
- 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
- Reconciled and recorded insurance determinations and benefit calculations with detailed accuracy utilizing extensive medical coding experience and tools including, ICD-9, ICD-10, HCPCS, and CPT
Education
Medical Billing Specialist Program - NHA: MCBC Certified
MedCerts
Livonia, MI02.2022
Medical Communication Ambassadors - Medical Interpreting Certified
10.2015
Bachelor of Science - Business Management
St. Joseph's College
Whiting, IN05.2000
Skills
- Insurance Types
- ICD-10-CM
- CPT
- HCPCS
- Billing
- Claim Processing
- Payment Adjudication
- Claim Statuses
- Resubmission Process
- Patient Information Verification
- Medical Interpreting
- Healthcare Administration
- Medical Claim Management
- Medical Billing & Coding
- Commercial Medical Claims Adjusting
- Benefits Coordination
- HIPAA
- Federal Insurance Regulations
- Microsoft Office
- Outlook
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
Caregiver
10.2020 - 05.2021
Health Care Coordinator
Blue Cross Blue Shield
09.2019 - 10.2020
Professional Development
03.2019 - 09.2019
Claims Adjuster
Combined Insurance
04.2015 - 03.2019
Medical Billing Specialist Program - NHA: MCBC Certified
MedCerts
Medical Communication Ambassadors - Medical Interpreting Certified
Bachelor of Science - Business Management
St. Joseph's College