Merlyn S Figueroa
Marrero,LA
Summary
Detail-oriented insurance claims specialist with extensive experience in complex policy processing and adeptness in various insurance software systems. Proven track record of interpreting policies and resolving claims efficiently, resulting in high levels of customer satisfaction. Recognized for exceptional accuracy in document processing and data entry, contributing to streamlined operations. Committed to enhancing workflows and team productivity for optimal claims resolution.
Overview
12
12
years of professional experience
Work History
Billing Customer Service Representative
Optum
Marrero, Louisiana
12.2024 - Current
- Developed strategies to reduce delinquent payments and improve overall customer satisfaction.
- Processed payments received.
- Handled customer inquiries and complaints regarding billing issues via telephone.
- Reviewed customer account records to ensure accuracy of all data entered into the system.
- Responded promptly to all customer requests for assistance with billing matters.
- Followed established guidelines while handling confidential information related to customer accounts.
- Actively monitored incoming calls for billing-related questions, inquiries from customers.
- Provided detailed information to customers about their accounts, including payment history and current balance due.
Sales & Seasonal Tax Preparation
Prestige Staffing & Services
Gretna, LA
01.2023 - Current
- Conducted daily communication with prospective clientele.
- Recognizing client requirements.
- Performed tax preparations efficiently.
- Payroll
- Bookkeeping
Medical Biller and Coder
CV EYE CARE CENTER
Gretna, Louisiana
08.2023 - 11.2024
- Monitored aging accounts receivable report weekly to identify unpaid balances due.
- Identified trends in denials and worked collaboratively with clinic staff to reduce denials.
- Utilized ICD-10, CPT, and HCPCS coding systems to process claims and billing.
- Worked closely with physicians to obtain additional clinical information when needed for accurate coding assignments.
- Expertly assigned charges and payments for medical procedures.
- Conducted audits to ensure compliance with federal and state regulations.
- Tracked details such as authorizations, pre-certifications or referrals required prior to service delivery.
- Developed an understanding of how various insurance plans process claims for reimbursement purposes.
- Assigned patients to diagnosis-related groups using appropriate computer software.
Medical receptionist
CV Eye Care Center
Gretna, LA
09.2022 - 11.2022
- Documented patient information thoroughly.
- Facilitated release of healthcare files strictly following governing policies.
- Ensured timely distribution of patient charts to assigned doctors.
- Ensured precise record-keeping through adherence to procedures.
- Delivered timely preparation of medical charts, paperwork, and reports.
- Maintained security protocols for safeguarding sensitive health information.
- Organized patient data by systematically updating medical records.
- Executed administrative responsibilities including managing calls, responding to electronic correspondences, and maintaining admission/discharge records.
- Entered insurance, demographics and health history into patient database.
- Scheduled and followed up on patient appointments, collected and processed patient payments and maintained patient files.
Patient account Rep
Fresenius Medical Care
Metairie, LA
10.2017 - 04.2022
- Generated and analyzed reports to identify patient account issues.
- Participated in numerous tasks assigned by immediate supervisor.
- Handled relocation of heavy objects with a weight capacity of 50 pounds.
- Detailed patient treatments and diagnoses in records.
- Corrected inaccuracies in billing by analyzing underpayments, overpayments, and documentation errors.
- Coordinating with insurance companies to confirm treatment coverage.
- Managed communication and coordination with various insurers.
- Resolved benefit discrepancies while adhering to company standards within specified timelines.
- Wrote appeal letters to insurance companies for denial of claims.
- Resolved any issues arising from incorrect or incomplete documentation relating to a particular claim.
- Contacted insurance companies to check status of claim payments.
- Reviewed EOBs statements submitted by insurance companies for accuracy against provider's charges.
Leasing Agent
CLK Multifamily Management
Harvey, LA
03.2013 - 09.2017
- Secured lease agreements through effective demonstrations.
- Prepare documentation for lease contracts and extensions.
- Assisted property manager in various tasks.
- Facilitated prompt assistance for residents, ensuring satisfaction.
- Taking maintenance work orders
- Verified readiness of all units prior to tenant occupancy.
- Handled the receipt and deposit of checks into the bank.
- Conducted daily property inspections ensuring compliance with apartment regulations.
- Marketing
Education
High school diploma -
Reading Senior High School
06.2009
Skills
- Fluent in English and Spanish
- Skill Development Training
- Customer Relationship Management
- Customer relations
- Time management abilities
- Policy adherence
- Experienced in Cross-Platform Computer Proficiency
- Expertise in Microsoft Office
- Effective Communication Skills
- Office Management
- Detail-Oriented Data Input
- EMR Software Proficiency
- Invoice processing
- Payment processing
- Refunds processing
- Money handling
- Team collaboration
- Inbound call answering
- Investigate claims
- Phone etiquette
- Billing procedures
Languages
Spanish
Native/ Bilingual
English
Native/ Bilingual
References
References available upon request.
Timeline
Billing Customer Service Representative
Optum
12.2024 - Current
Medical Biller and Coder
CV EYE CARE CENTER
08.2023 - 11.2024
Sales & Seasonal Tax Preparation
Prestige Staffing & Services
01.2023 - Current
Medical receptionist
CV Eye Care Center
09.2022 - 11.2022
Patient account Rep
Fresenius Medical Care
10.2017 - 04.2022
Leasing Agent
CLK Multifamily Management
03.2013 - 09.2017
High school diploma -
Reading Senior High School
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