MARISOL CARRILLO
Albuquerque,NM
Summary
Productive Data Entry Operator, skilled in accuracy and efficiency. Seasoned Health Plan Specialist with 10 years of experience assisting providers and members. With a background in finance, evaluating financial status and implementing resolutions.
Specialties include supporting customers, providers and members with strong attention to detail and accuracy.
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
12
12
years of professional experience
Work History
Data Entry Operator
Human Services Department
Albuquerque, NM
06.2023 - Current
- Processed Medicaid application and renewals.
- 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
Albuquerque, NM
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.
- 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.
Accounts Receivable Specialist
UNM Hospital
Albuquerque, NM
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.
- Filed appeals within timely with supporting documentation.
- Submitted medical records and remittance advice to insurance as requested.
- Adjusted, wrote off and transferred charges per explanation of benefits.
- Researched accounts with credits.
Health Plan Specialist
Presbyterian
Albuquerque
05.2012 - 05.2014
- Responsibility was answering incoming phone calls for members and providers to provide accurate information.
- Researched policy provisions to determine coverage levels, limitations, and exclusions.
- Reconciled discrepancies between the Explanation of Benefits statement and the submitted claim form.
- Evaluated 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.
Education
Psychology -
University of New Mexico
01.2017
High School Diploma -
West Mesa High School
06.2010
Skills
- Bilingual Spanish: Expert read, write and speak
- Availity, Medicaid Portal, Soarian, Huron and Insurance portals
- Medical Claims processing
- 10 years Experience with Medicaid, Medicare and Commercial Insurance
- Word, Power Point, Internet, Email, Windows, Excel
- Communication skills
- Time management
- Strong documentation skills
- Financial Consulting
- Strategic Planning
- Debt management
- Collections
Timeline
Data Entry Operator
Human Services Department
06.2023 - Current
Financial Account Specialist
American Credit Acceptance
10.2020 - 08.2022
Accounts Receivable Specialist
UNM Hospital
01.2019 - 10.2020
Health Plan Specialist
Presbyterian
05.2012 - 05.2014
Psychology -
University of New Mexico
High School Diploma -
West Mesa High School
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