Open To Work
Julia Rios
Spring Valley,NY
Work Preference
Summary
To find a position that utilizes my administrative and bilingual skills with possibilities for advancement.
Knowledgeable and with extensive experience in analyzing and processing claims accurately and efficiently. Proven track record in resolving complex claims and ensuring compliance with industry and state standards. Demonstrated ability in utilizing analytical skills and attention to detail to support team goals and improve operational processes.
Overview
23
23
years of professional experience
Work History
Claims Analyst
Therapeutic Resource and HTA of New York, Inc.
Astoria and New City, New York
03.2010 - 04.2026
- Submitted & resubmitted claims for payment to Early Intervention via the New York State Health Commerce System.
- Imported electronic payments received from Medicaid and the State on a weekly and bi-weekly basis.
- Kept a detailed weekly and month to month record of monies we have received.
- Investigated & sent corresponding worksheets & waivers for unpaid claims including ABA cases.
- Billed for assistive tech devices
- Analyzed claims data to identify trends and discrepancies, improving accuracy in processing procedures.
- Led training sessions on new systems and processes for staff, improving overall operational efficiency within the department.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Collaborated with the state to resolve complex claim issues, ensuring payment for our agency.
- Maintained strict confidentiality with all personal data as per HIPAA guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support payment.
- Followed up on potentially fraudulent claims initiated by Providers and employees
- Collected personal information from Service Coordinators and parents to process claims.
Interpreter
John DeCastris
Suffern , New York
01.2023 - 06.2025
- Utilized active listening skills and cultural sensitivity to convey accurate interpretations.
- Maintained message content, tone, and emotion as closely as possible.
- Enhanced communication between clients and non-English speakers by providing accurate translations in real-time conversations.
- Communicated with clients to understand interpreting needs and provide best service possible.
- Collaborated with other interpreters to cross-check accuracy of interpretations.
- Prepared for interpreting tasks by researching and gathering information about tasks beforehand.
- Enabled effective communication during crisis situations, remaining calm under pressure while delivering accurate verbal translations quickly and efficiently.
- Supported a High School in translating final exams for non-English speaking students.
Health Insurance Agent
Health Insurance
07.2008 - 06.2009
- Customer service skills utilized.
- Guided clients in selecting suitable health insurance plans based on individual needs.
- Educated clients on policy benefits, coverage options, and enrollment procedures.
- Maintained compliance with all industry regulations while completing paperwork accurately and efficiently.
- Called prospects for insurance
- Provided potential clients with health insurance quotes
- Followed up with clients with regards to questions and concerns
- Utilized bilingual skills
Loan Processor
ACE Mortgage
05.2007 - 04.2008
- Uploaded loan information & documents to different financial institutions.
- Order loan payoffs, VOE, VOM
- Calculated income, DTI
- Customer Service
- Interpreted loan information to Spanish speaking clients.
- Clerical & receptionist skills utilized.
- Processed loan applications efficiently, ensuring compliance with industry regulations.
Insurance Claims Clerk
Abrankian Back & Neck Center
05.2003 - 02.2006
- Collected money on insurance claims
- Data entry
- Receptionist duties
- Scheduled appointments for patients
- Calculated payments and co-payments
- Assisted patients in filling out insurance forms
- Verified insurance coverage
- Responsible for opening and closing office
- Bilingual skills utilized
- Reviewed policy documents for completeness and adherence to regulatory standards.
Education
High School -
Governor Mifflin High School
Shillington, PA06-1995
Skills
- Claim investigation
- Dispute tracking
- Skilled in Excel, Windows, Microsoft Word, Quick Books and Outlook
- Type 60wpm
- Bilingual
- Critical thinking
- Active listening
- Payment processing
- Public speaking
- Customer service
- Problem-solving abilities
Languages
Spanish
Native or Bilingual
Timeline
Interpreter
John DeCastris
01.2023 - 06.2025
Claims Analyst
Therapeutic Resource and HTA of New York, Inc.
03.2010 - 04.2026
Health Insurance Agent
Health Insurance
07.2008 - 06.2009
Loan Processor
ACE Mortgage
05.2007 - 04.2008
Insurance Claims Clerk
Abrankian Back & Neck Center
05.2003 - 02.2006
High School -
Governor Mifflin High School