Michelle Jurado
Miramar,FL
Summary
Results driven professional with over 5 years of hands-on experience in account management, revenue generation, auditing and provider contracts revision. Accomplished in developing strategies to improve workflow and processes, and actualizing procedures to enhance revenue generation and company goals. Demonstrated leadership skills guide teams towards success, optimize performance and sustain organizational success.
Overview
12
12
years of professional experience
Work History
Value Base Professional
Humana
Miramar, FL
09.2020 - Current
- Review and analyze financial documents and/or contracts to ensure the accuracy of financial terms within the contract.
- Serve as a point of contact for questions related to assigned accounts at the PCP, SPC and National Level.
- Extract data from reporting systems to implement operational changes.
- Manage the markets assigned and prioritize the workload
- Conduct audits on work completed on a monthly basis to maintain quality standards and error-free reports
Grievance and Appeals Representative 3
CarePlus Health Plans Inc.
Doral, FL
08.2019 - 09.2020
- Managed client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted
- Performed advanced administrative, operational, customer support duties that require independent initiative and judgment
- Investigated and resolved member and provider issues focusing on methods, tactics and processes for completing administrative tasks/projects
- Collected, analyzed and interpreted trend information to address and resolve non-routine business-related concerns
- Built Humana’s brand image with employers, members, brokers, consultants, physicians, hospitals, regulators and legislators by providing effective and efficient service
Medical Biller and Coder & General Office Assistance
Total Women Wellness Center
Miami, Florida
06.2016 - 06.2019
- Implemented new Financial systems and created a more efficient patient flow and a higher collection of point-of-service revenue
- Amended policies and procedures for office functions, including productivity benchmarks for payment posting, charge entry, claims processing and insurance follow-up positions
- Collaborated with manager in credential process and to negotiate insurance contracts with all major HMO/PPO policies including Medicaid plans
- Managed collections accounts, set up payment plans and collection of payments
- Created financial reports, analyzed data and prepared strategy to achieve company goal
- Evaluated services and Plan Performance Improvement strategy for training and maximizing results
- Retrieved medical records from Hospitals and kept patient's charts updated with 100% accuracy
- Implemented electronic payment posting and increased electronic claims filling to over 90%
- Managed company's social media, renovated information and events in a timely manner
- Performed front desk duties as needed and assisted with Spanish translation
- Assessed medical codes on patient records and prepared invoices to be submitted to insurance companies commercial and Medicaid plans
- Performed insurance verification, pre-certification and pre-authorization
- Applied HIPAA Privacy and Security Regulations while handling patient information
- Participated in educational opportunities, including workshops, seminars and training classes to gain a stronger education in industry updates and federal regulations
Medical Biller
Mount Sinai Medical Center
Miami Beach, FL
12.2014 - 02.2015
- Reviewed daily reports for insurance payments, denials and patient responsibility and sent invoices to proper party payer with 100% accuracy
- Reviewed all claims for accurateness and appropriateness
- Assisted patients about financial inquires with excellent customer service skills
- Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices
Medical Biller
Physicians Group of South Florida
Miami, Florida
03.2012 - 12.2014
- Verified insurance eligibility and information with 100% accuracy
- Estimated financial out of pocket costs for out/in-patient services
- Collected and posted patient payments and maintained financial aging accounts updated
- Coded, billed, corrected and appealed medical claims in a timely manner with proven results
- Addressed and responded to staff and client inquiries regarding CPT and diagnosis codes
- Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes
- Reviewed and abstracted relevant clinical data from electronic medical records to select appropriate code for procedures
Education
Certificate of Completion - Business Analytics
University of South Florida
Tampa, FL05-2024
MBA - Business Administration
Florida International University
Miami, FL04-2021
Bachelor of Business Administration (BBA) - Business Administration
Florida International University
2018
Associate of Arts - Business Administration
Miami Dade College
Miami12.2015
Associate of Science - Health Information Management
Miami Dade College
Miami, FL12.2014
Skills
- Account management
- Customer service
- Financial reporting
- Data security procedures
- Leadership
- Ability to set priorities and meet challenging deadlines
- Ability to learn quickly and multi-task
- Strong organizational skills
- Electronic Health Record experience
- Problem-solving and reasoning
- Auditing
Timeline
Value Base Professional
Humana
09.2020 - Current
Grievance and Appeals Representative 3
CarePlus Health Plans Inc.
08.2019 - 09.2020
Medical Biller and Coder & General Office Assistance
Total Women Wellness Center
06.2016 - 06.2019
Medical Biller
Mount Sinai Medical Center
12.2014 - 02.2015
Medical Biller
Physicians Group of South Florida
03.2012 - 12.2014
Certificate of Completion - Business Analytics
University of South Florida
MBA - Business Administration
Florida International University
Bachelor of Business Administration (BBA) - Business Administration
Florida International University
Associate of Arts - Business Administration
Miami Dade College
Associate of Science - Health Information Management
Miami Dade College