MARISOL CARRILLO
Albuquerque,NM
Summary
Versatile and results-driven professional with over 10 years of experience in healthcare and financial sectors, notably at UNM Hospital. Excelled in medical claims processing and financial consulting, leveraging bilingual Spanish proficiency and exceptional communication skills. Achieved significant improvements in billing accuracy and client satisfaction through strategic planning and effective problem-solving.
Skilled Mental Health Technician with children/youth. Supported numerous patients in large residential treatment facility and played key role in achievement of positive patient outcomes. Excellent communications and patient management skills leading to desirable results.
Overview
12
12
years of professional experience
Work History
Data Entry Operator
Human Services Department
06.2023 - 06.2024
- Processed intake for Medicaid and Medicare applications.
- Processed renewals for Medicaid, Medicare.
- Reviewed and processed supporting documentation client provided.
- Verified income and unearned income with internal and external systems.
- Maintained data entry requirements by following data program techniques and procedures.
- Identified, corrected, and reported data entry errors.
- Compiled data from source documents prior to data entry.
- Maintained confidentiality of client and staff personal details by adhering to company regulations and requirements.
- Gathered and documented statistical information to generate reports.
- Conducted quality checks to verify accuracy, integrity and completeness after entry.
Financial Account Specialist
American Credit Acceptance
10.2020 - 08.2022
- Initiated customer contact and evaluated customers financial situation.
- Reviewed financial status and evaluated discrepancies by assessing account information and activities.
- Established customer rapport to quickly mitigate problems while complying with established support processes and procedures.
- Negotiated financial plan within company and customer benefits.
- Processed payment in secure third party payment system.
- Used the auto-dial system to initiate customer contact.
- Used skip trace tool when needed to find additional customer contact information.
- Prepared reports for financial payment plans
Accounts Receivable Specialist
UNM Hospital
01.2019 - 10.2020
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Evaluated open accounts to look for past-due balances and pursue collection strategies.
- Communicated with private and government insurance companies to resolve claim issues to ensure correct payment.
- Researched CPT coding, modifiers and MUE threshold.
- Ensured correct use of adjustment codes and activity codes.
- Verified eligibility and benefits through online portals to process claims.
- Filed claim appeals within timely with supporting documentation.
- Submitted medical records and remittance advice to insurance as requested so claim can be paid correctly.
- Adjusted, wrote off and transferred charges per explanation of benefits.
- Researched accounts with medical billing credits.
Customer Service Advocate
Blue Cross Blue Shield
07.2016 - 01.2018
- Answered inbound calls from existing and future policyholders to answer inquiries and discuss insurance options.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Collaborated with healthcare providers to ensure accurate billing practices, reducing disputes and errors.
- Managed high call volume while maintaining exceptional customer service standards, leading to positive feedback from clients.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
Health Plan Specialist
Presbyterian
04.2014 - 04.2016
- Researched policy provisions to determine medical coverage levels, limitations, and exclusions.
- Reconciled discrepancies between the Explanation of Benefits statement and the submitted claim form.
- Investigated medical insurance claims to ensure accuracy and completeness of documents.
- Verified insurance coverage and eligibility for services provided.
- Processed premium payments for the NM Health Exchange.
- Worked with the prior authorization team providing details to providers.
- Assisted members and providers with online portal access.
- Documented all customer and provider interactions according to established protocols.
- Helped implement training for new employees assisting providers and members.
Mental Health Support Worker
Desert Hills
01.2012 - 02.2014
- Supported children/youth patients in achieving personal goals through goal-setting exercises and step-by-step guidance.
- Enhanced children/youth patients well-being by providing empathetic and compassionate support in daily activities.
- Recognized and responded to signs of potential self-harm or suicide risk, utilizing appropriate intervention strategies and resources to ensure patient safety.
- Applied de-escalation and limit-setting techniques to promote patient cooperation.
Education
Bachelor of Science - Psychology
Grand Canyon University
Albuquerque, NM05-2026
Psychology -
University of New Mexico
Albuquerque, NM01-2015
High School Diploma -
West Mesa High School
Albuquerque, NM06.2010
Skills
- Bilingual Spanish: Expert read, write and speak
- Availity, Medicaid Portal, Soarian, Huron and Insurance portals
- Medical Claims processing
- Word, Power Point, Internet, Email, Windows, Excel
- Communication skills
- Time management
- Strong documentation skills
- Financial Consulting
- Debt management
- SHARE
- ASPEN
- Youth program management
- Child safety protocols
- De-escalation techniques
- Patient safety management
- Treatment Planning
- Family relations
- Behavior management
- Crisis intervention
- Substance abuse awareness
- Behavioral management
- Patient assessment
Timeline
Data Entry Operator
Human Services Department
06.2023 - 06.2024
Financial Account Specialist
American Credit Acceptance
10.2020 - 08.2022
Accounts Receivable Specialist
UNM Hospital
01.2019 - 10.2020
Customer Service Advocate
Blue Cross Blue Shield
07.2016 - 01.2018
Health Plan Specialist
Presbyterian
04.2014 - 04.2016
Mental Health Support Worker
Desert Hills
01.2012 - 02.2014
High School Diploma -
West Mesa High School
Bachelor of Science - Psychology
Grand Canyon University
Psychology -
University of New Mexico
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