Maribel Torres
Deltona,FL
Summary
Hardworking and reliable Insurance verification with strong ability in Customer Service and Data Base Offering Teamwork, Interpersonal skills and Persistence. Highly organized, proactive and punctual with team-oriented mentality.
Overview
20
20
years of professional experience
Work History
Medical Insurance Specialist/Medical Coding and Billing Specialist
Central Florida Bone and Joint Institute
Orange City , FL
01.2017 - Current
- Maintained up-to-date understanding of insurance payment practices.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Sent clinical request and missing information letters to obtain incomplete information.
- Documented file notes clearly and concisely in Modmed.
- Explained coverage options to potential policyholders, answering questions or concerns.
- Monitored clients' insurance coverages to ensure changing needs were met.
- Reviewed insurance inquiries, working effectively to accommodate various requests to build agency's reputation as service provider.
- Handled payment processing and provided customers with receipts and proper bills and change.
- Welcomed patrons to front desk and engaged in friendly conversations while conducting check-in process.
- Received incoming calls and coordinated with hotel staff to fulfill requests and resolve issues.
- Prepared daily shift close reports and balanced cash register to accurately reflect all transactions.
- Responded to inquiries and room requests made online, by phone or email.
- Signed for packages, recorded deliveries and distributed to personnel.
- Maintained accurate bookkeeping of important files, running reports and delivering updates on occupancy and revenues.
- Scheduled and confirmed appointments.
- Reviewed and processed medical insurance claims to ensure accuracy of information and compliance with established regulations.
- Analyzed patient records to determine eligibility for coverage, benefit levels, and other related matters.
- Resolved complex insurance issues by communicating with providers, patients, and third-party payers.
- Processed payments for services rendered in accordance with the terms of the policy or contract.
- Investigated discrepancies between billed charges and approved payment amounts from third party payers.
- Researched medical codes used in billing processes to ensure accuracy of documentation.
- Handled third-party insurance processing tasks to assist patients.
- Reviewed claims for accuracy before submitting for billing.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
Tour Coordinator/Supervisor
Dragonfly Adventures
Rio Grande, Puerto Rico
02.2013 - 05.2016
- Asked open-ended questions to best understand client needs and determine best travel offerings.
- Established base of loyal clientele due to excellent listening and research skills and keen understanding of travel budgets.
- Cultivated strong value-added relationships with customers daily by delivering accurate travel itinerary and knowledge to drive business development.
- Explained benefits of purchasing travel insurance with clients.
- Researched and created memorable and exquisite travel itineraries for high-level clients, celebrities, politicians and business executives.
- Automated office operations to manage client correspondence, record tracking and data communications.
- Achieved top satisfaction, retention and referral rankings on consistent basis.
- Improved productivity initiatives, managing office support tasks and coordinating itinerary and scheduling appointments.
Servi-express Supervisor
Gran Melia Hotel - Rio Grande
Rio Grande, Puerto Rico
08.2007 - 06.2010
- Directed and supervised staff performance.
- Responded to customer inquiries and delivered appropriate information after carefully researching issues.
- Identified appropriate solutions to minimize issues and quickly solve problems.
- Instructed staff on procedures for handling difficult transactions.
- Ordered merchandise with accuracy by verifying back stock and maintaining inventories.
- Trained and developed [Number] employees through constructive feedback and focus on long-term career growth.
- Delivered empathy and persuasive negotiation talents to promote memorable customer experience.
- Established, enforced and optimized departmental procedures and goals to optimize team performance and productivity.
- Wrote and submitted reports.
Housekeeping Supervisor
Gran Melia Hotel - Rio Grande
Rio Grande, Puerto Rico
05.2007 - 08.2007
- Supervised and supported housekeeping personnel to maximize quality of service and performance.
- Stocked room attendant carts with supplies to keep carts organized and clean.
- Collaborated with front desk to respond promptly to guest requests and promote positive experience.
- Reviewed employee performance and devised improvement plan to achieve goals.
- Submitted repair requests to maintenance team to reduce operating costs and improve energy-saving strategy.
- Established hands-on, proactive management style to facilitate improvements to workflow and room turnover.
Customer Service Representative
Gran Melia Hotel - Rio Grande
Rio Grande, Puerto Rico
02.2004 - 05.2007
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Documented conversations with customers to track requests, problems and solutions.
- Fielded customer complaints and queries, fast-tracking them for problem resolution.
- Upheld strict quality control policies and procedures during customer interactions.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Trained new employees on procedures and policies to maximize team performance.
Education
Medical Science
Midwood High School
Brooklyn, NY06.1993
Licensed Practical Nurse
Instituto De Banca Y Comercio - San Juan
San Juan, PR05.2000
Medical Coding And Billing
Florida Technical College
Fl12.2016
Skills
- Customer follow-up
- Work ethic
- Communication
- Workers Compensation
- Motor Vehicle Accidents
- Reviewing Providers notes
- Insurance verification
- Proficiency in Phoenix Otho, Open Practice and Modernizing Medicine
Languages
English
Professional
Spanish
Professional
Timeline
Medical Insurance Specialist/Medical Coding and Billing Specialist
Central Florida Bone and Joint Institute
01.2017 - Current
Tour Coordinator/Supervisor
Dragonfly Adventures
02.2013 - 05.2016
Servi-express Supervisor
Gran Melia Hotel - Rio Grande
08.2007 - 06.2010
Housekeeping Supervisor
Gran Melia Hotel - Rio Grande
05.2007 - 08.2007
Customer Service Representative
Gran Melia Hotel - Rio Grande
02.2004 - 05.2007
Medical Science
Midwood High School
Licensed Practical Nurse
Instituto De Banca Y Comercio - San Juan
Medical Coding And Billing
Florida Technical College
Similar Profiles
Cheryl JohnsonCheryl Johnson
Physical Therapy Aide at Illinois Bone And Joint InstitutePhysical Therapy Aide at Illinois Bone And Joint Institute
Alexander Micahel Ilija KulacicAlexander Micahel Ilija Kulacic
Prior Authorization Specialist at Illinois Bone and Joint InstitutePrior Authorization Specialist at Illinois Bone and Joint Institute
ALLYSON SIROISALLYSON SIROIS
Registered Nurse at Hartford Hospital Bone and Joint InstituteRegistered Nurse at Hartford Hospital Bone and Joint Institute