Mercy Delmontes
Schenectady
Summary
Experienced premium auditor seeking opportunities to expand knowledge and enhance professional experience. Proficient in Excel and Visual, enabling efficient assessment and resolution of client needs. Prioritizes transparent communication and trust-building with insured individuals and collaborating agencies. Recognized for responsibility, attention to detail, respect, and organizational skills, committed to delivering high-quality results and inspiring colleagues to uphold professionalism and integrity. Goal-oriented in creating positive and productive environments that foster collaboration and mutual respect, aiming to contribute to growth, innovation, and success for all involved. Positive and analytical problem-solver with a knack for detail and accuracy. Well-versed in financial principles and auditing standards, possessing effective skills in data analysis and reporting. Aims to drive compliance and efficiency in financial operations. Offers a solid foundation in analytical thinking and problem-solving, well-suited for adapting to new challenges and environments. Brings the ability to quickly learn and apply data analysis techniques. Ready to use and develop these skills in the desired position role.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Premium Auditor
Berkshire Hathaway GUARD Insurance Companies
02.2023 - 05.2024
- Accurately determining the final premium for Workers' Compensation and Business Owner Policies requires validating assigned class codes and properly classifying payroll, sales, and subcontractor costs
- This process is accomplished through a meticulous audit of the policyholders' records conducted via correspondence or telephone communication
- Serve as the primary liaison for policyholders throughout the audit process, delivering exemplary customer service, support, and education to facilitate the prompt completion of audits
- Address any audit disputes to ensure they are managed appropriately
- To ascertain chargeable exposures in accordance with state laws and relevant manuals, it is imperative to conduct a comprehensive review of audit worksheets, payroll journals, sales reports, profit and loss statements, tax documentation, and various other reports
- Conduct a thorough review of business operations by employing telephone interviews, audit worksheets, documentation, applications, and internet searches
- This process is essential to ensure that classifications are accurately assigned in accordance with state laws and regulatory manuals
- Complete the audit worksheets utilizing the provided Excel template and subsequently process the audit findings within our proprietary policy system
Auditor
NEIS, Inc.
11.2021 - 10.2022
- Worker's compensation and general liability audits require comprehensive oversight and submission of all requisite documentation
- Effective communication with insurance agencies, policyholders, Certified Public Accountants (CPAs), and payroll providers is essential for successfully collecting the required information
- A detailed review of documents, including1099 forms, IRS Form941, sales data, profit and loss statements, general ledger reports, and certificates of insurance, must be conducted
- Additionally, phone audits should be performed efficiently
- Finally, a thorough audit review is imperative to ensure accuracy and precision in finalizing the assigned audits
Unbilled/ ACO Representative Ops
CVS Healthcare
03.2019 - 08.2022
- Contact medical offices and hospitals to verify that order forms are signed by Medicare and Medicaid guidelines
- Possess comprehensive knowledge of insurance services and the various policy requirements
- Demonstrate exceptional customer service skills over the phone and through email
- Assist with the preparation of company financial reports for metric analysis
- Undertake document review and tracking responsibilities
- Implement productivity processes effectively
- Maintain communication with district managers to ensure timely processing of company payments via email
- Exhibit proficiency in medications and relevant calculations
- Possess knowledge of Salesforce and familiarity with HCN360 and DiA/ECM systems
- Fax and email orders to medical doctors as necessary
- Ensure all Medicare documents, including ABNs/DIFs and consent forms, are signed promptly
Administrative Support Associate/ Health Unit Coordinator
Albany Medical Center/ Medical Surgical ICU
10.2013 - 01.2018
- As an ASA V and Health Unit Coordinator, our responsibilities encompass providing exceptional customer service, conducting clerical tasks, and managing reception duties to facilitate the workflow of the unit, nursing station, and overall delivery of patient care
- The clerical functions involve ensuring the precise preparation, processing, transcription, and standardization of patient records, as well as the effective utilization of clinical information systems
Patient Care Associate
Albany Medical Center/ Vascular Surgery
07.2008 - 10.2013
- Providing direct patient care entails actively engaging with individuals to address their healthcare requirements
- This process includes assisting patients with essential activities of daily living (ADLs), such as bathing, dressing, grooming, eating, and toileting
- It is imperative to support patients in maintaining their independence while ensuring their safety and comfort
- Furthermore, promoting patient mobility is a critical component of care; this involves encouraging physical movement and offering assistance with exercises or ambulation as necessary to enhance strength and mitigate complications associated with inactivity
- Adequate documentation of these activities is vital to monitor progress and facilitate effective communication within the healthcare team
- This encompasses vital signs assessment, glucose monitoring, rapid response initiatives, coding, and the provision of life-saving measures, in addition to assisting physicians and nurses with medical procedures
Education
Master's degree - Business Administration with Concentration in Public Administration
Southern New Hampshire University
Manchester, NHBachelors - Business Administration with concentration in Public Administration
Southern New Hampshire University
06.2023
Associate - Public Administration
Hudson Valley Community College
Troy, NY05.2017
High school diploma - undefined
Albany High School
Albany, NY06.2005
Skills
- EMR Systems
- Business analysis
- Leadership
- BOP
- General Liability
- Audit
- Critical care experience
- General ledger accounting
- Research
- Adobe
- Epidemiology
- Document management
- Databases
- Cerner
- Lexis-Nexis
- Microsoft Office
- DocuSign
- Medical terminology
- Document review
- Patient monitoring
- Transcription
- Remote
- Data collection/ data entry
- HIPAA
- Insurance knowledge
- Workers' compensation law
- Contracts
- Archival standards
- Customer Service
- Medical Documentation
- Medical records management
- Patient Care
- Medicare
- InVision
- Inbound calls / outbound calls
- Sales
- Salesforce
- Advocate
- Disputes
- Compliance
- Investigation
- Leadership
- Supervision
- Attention to detail
- Decision-making
- Audit reporting
- Process evaluations
- External auditing
- Report creation
- Account reconciliation
- Financial reporting
- Financial management
- Root-cause analysis
- Issue resolution
- Risk mitigation strategies
- Financial records review
- Cost reduction options
- Regulatory filings
- Report writing
- Regulatory compliance
- GAAP proficiency
- Profits and losses tracking
- Data analytics
- Report generation
- Analytical problem solving
- Risk assessment
- Ethical judgment
- Ethical standards
- General ledger
- Conflict negotiation and resolution
- Accounting records analysis
- Time management
- Critical thinking
- Multitasking and organization
- Client relationship management
- Financial auditing
- Quality assurance
- Project management
- Analytical research
- General accounting
- Relationship building
- MS Excel
- Analytical thinking
- Information gathering
- Data research and validation
- Data processing
- Risk analysis
- Workflow Analysis
- Evidence-based decision making
- Risk mitigation
- Incident reporting
- Deadline adherence
- Verbal and written communication
Certification
- Emotional Intelligence Certification November2024 to Present
- Leading vs Managing Certification November2024 to Present
- Time Management tips for time crunched professionals certification November2024 to Present
- Critical Thinking Skills Certification October2024 to Present
Groups
The National Society of Leadership and Success- Sigma Alpha Pi. May 2022 to Present We are dedicated to maintaining transparency, integrity, and fairness in all of our communications and actions. As we navigate the complexities of leadership development, we approach each challenge with enthusiasm and commitment. Our objective is not merely to meet expectations but to surpass them, facilitating meaningful actions and generating a lasting impact. Together, we can achieve exceptional outcomes.
Timeline
Premium Auditor
Berkshire Hathaway GUARD Insurance Companies
02.2023 - 05.2024
Auditor
NEIS, Inc.
11.2021 - 10.2022
Unbilled/ ACO Representative Ops
CVS Healthcare
03.2019 - 08.2022
Administrative Support Associate/ Health Unit Coordinator
Albany Medical Center/ Medical Surgical ICU
10.2013 - 01.2018
Patient Care Associate
Albany Medical Center/ Vascular Surgery
07.2008 - 10.2013
Bachelors - Business Administration with concentration in Public Administration
Southern New Hampshire University
Associate - Public Administration
Hudson Valley Community College
High school diploma - undefined
Albany High School
- Emotional Intelligence Certification November2024 to Present
- Leading vs Managing Certification November2024 to Present
- Time Management tips for time crunched professionals certification November2024 to Present
- Critical Thinking Skills Certification October2024 to Present
Master's degree - Business Administration with Concentration in Public Administration
Southern New Hampshire University
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