Mariel Molitorisz
Bradenton,FL
Summary
Dynamic Claims Adjudicator with proven expertise at AblePay Health LLC in claims processing and regulatory compliance. Recognized for reducing errors and enhancing operational efficiency through data analysis and effective communication. A dedicated patient advocate skilled in discrepancy resolution and team collaboration, consistently exceeding performance targets to drive departmental success.
Overview
14
14
years of professional experience
Work History
Claims Adjudicator
AblePay Health LLC
02.2024 - 08.2025
- Reviewed and processed claims efficiently, ensuring compliance with company policies and regulations.
- Collaborated with healthcare providers to resolve claim discrepancies and improve processing accuracy.
- Analyzed claim data to identify trends and recommend improvements in adjudication processes.
- Communicated effectively with clients to explain claims decisions and address inquiries.
- Monitored workflow to enhance operational efficiency and reduce turnaround times for claim resolutions.
- Reduced errors in claims adjudication through diligent review of policies and thorough investigation of claims.
- Consistently met or exceeded performance targets for claims processing and adjudication, contributing to overall departmental success.
- Maintained detailed records of all claims-related activities, fostering transparency and accountability within the department.
- Collaborated with team members and management to meet goals.
Patient Benefits Specialist
Robbins Rehabilitation East
10.2020 - 10.2023
- Assisted patients in understanding benefits eligibility and coverage options.
- Processed benefit claims efficiently to ensure timely resolution for patient inquiries.
- Collaborated with healthcare providers to gather necessary documentation for claim approvals.
- Maintained accurate patient records and updated benefit information in the system.
- Educated patients on insurance policies and procedures to enhance their understanding of available services.
- Analyzed claims data to identify trends and recommend improvements in processes.
- Coordinated with internal teams to resolve discrepancies in benefit claims and patient accounts.
- Supported outreach efforts to improve patient engagement regarding benefits enrollment and utilization.
- Reduced claim denials through diligent verification of patient insurance information and coordination with billing departments.
- Assisted in maintaining compliance with regulatory requirements by staying up-to-date on industry changes and updating internal processes accordingly.
- Supported continuous quality improvement efforts by participating in staff meetings, trainings, and performance evaluations related to the Patient Benefits Specialist role.
- Expedited claim processing times by promptly submitting documentation required for prior authorizations or appeals on behalf of patients.
- Created customized financial assistance packages for patients experiencing hardships, ensuring they maintained access to necessary healthcare services.
- Improved patient satisfaction by addressing inquiries and resolving issues related to benefits, eligibility, and coverage.
- Established a positive rapport with patients during encounters while maintaining strict confidentiality standards as required under HIPAA regulations.
- Observed strict procedures to maintain data and plan participant confidentiality.
Insurance Coordinator
Lehigh Valley Hospital and Health Network
02.2012 - 10.2020
- Coordinated insurance verification processes to ensure timely patient care access.
- Managed claims submissions, ensuring compliance with regulatory standards and accuracy.
- Developed training materials for new staff on insurance policies and procedures.
- Streamlined communication between departments to enhance workflow efficiency in insurance processing.
- Oversaw resolution of complex billing issues, improving patient satisfaction and retention rates.
- Verified insurance and communicated coverage to staff and patients.
- Assisted clients with understanding complex insurance policies, effectively addressing concerns or questions.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Contributed positively to team morale by consistently demonstrating a collaborative attitude and willingness to support colleagues.
- Assisted in resolving complex insurance claims, liaising between clients and providers for favorable outcomes.
Education
High School Diploma -
Bethlehem Catholic High School
Bethlehem, PASkills
- Claims processing
- Regulatory compliance
- Data analysis
- Workflow optimization
- Benefit verification
- Patient advocacy
- Insurance coordination
- Discrepancy resolution
- Quality improvement
- Coverage education
- Staff collaboration
- Policy coverage expertise
Timeline
Claims Adjudicator
AblePay Health LLC
02.2024 - 08.2025
Patient Benefits Specialist
Robbins Rehabilitation East
10.2020 - 10.2023
Insurance Coordinator
Lehigh Valley Hospital and Health Network
02.2012 - 10.2020
High School Diploma -
Bethlehem Catholic High School