Nieves Rodriguez
Marlton
Summary
Motivated professional eager to embrace new challenges. Demonstrates strong work ethic and adaptability, with proven interpersonal skills. Capable of working independently and rapidly acquiring new competencies.
Overview
11
11
years of professional experience
Work History
Provider Enrollment Analyst
Amerihealth Caritas
12.2022 - Current
- Collect and review provider documents like licenses, certifications, malpractice insurance, and practice information to confirm provider eligibility
- Conduct thorough background checks on providers to verify their qualifications and compliance with regulatory standards.
- Streamline data collection methods from different plans to create automated and easy-to-use routines
- Maintain accurate provider information within AmeriHealth's database, including practice locations, contact details, and specialty codes
- Facilitated claims resolution by collaborating with Enterprise Operations, providers, and Provider Network Management.
- Answer questions, address concerns, and provide updates on the enrollment status to the plans throughout the process
- Stay updated on changing regulations and ensuring provider enrollment adheres to all applicable laws.
- Identify and address any discrepancies or problems with provider applications, work to resolve them efficiently.
- Investigate, resolve and communicate provider claim issues and changes
Billing Administrator
Advantage Behavioral Health
Marlton
05.2021 - 12.2022
- Manage and execute billing of outbound insurance claims at a high volume.
- Identify, research, and ensure timely processing of ERA payments and error corrections, ensuring appropriate documentation of payments, allowances, denial, rejections, are recorded on individual accounts
- Coordinate with other members of billing team to appeal insurance denials
- Balance and reconcile cash payments
- Post and Reconcile all insurance payments, checks and mail correspondence
- Follow up with third party payers and patients for services received in accordance with facility policy and procedures.
- Monitored unpaid claims and resubmits claims with appropriate corrections and/or documentation.
- Collect patient payments, set up patient on payment plans and post to accounts
Accounts Receivables
Paths, LLC
Pennsauken
12.2020 - 05.2021
- Process bills to contracted payors
- Analyze Explanation of Benefits (EOB) or Remittance Advice (ERA) received from an insurance carrier and take appropriate action according to company guidelines
- Follow-up with insurance companies and patients for payments
- Review and appeal denied claims
- Identify and resolve outstanding issues preventing claim resolution
- Correct and resubmit claims
- Documentation and data entry
Medical Biller
Jefferson Surgery Center
Cherry Hill
08.2019 - 07.2020
- Ensured unpaid claims and partially paid claims are resolved in an efficient and timely manner with a focus on cash collections.
- Monitored unpaid claims and resubmits claims with appropriate corrections and/or documentation
- Researched ‘no response’ claims. Reports root cause to supervisor. Handles claim for payment accordingly.
- Addressed all electronic scrubbing errors to ensure claims get to the payer timely.
- Answered patient and family member questions regarding financial responsibility and explain insurance requirements and refer questions to healthcare professionals when appropriate.
- Communicated pertinent information from the physician, support staff, insurance companies and other significant parties to the patient.
- Verified patients’ insurance eligibility and benefits electronically and/or on the phone.
- Billed and follow up with third party payers and patients for services received in accordance with facility policy and procedures.
- Prepared all bank deposits following facility controls.
Medical Billing Specialist
Sutherland (Third Party Billing Co)
Clifton
03.2019 - 08.2019
- Responsible for timely follow up on patient balances.
- Answered inbound calls from patients, insurance & other third-party businesses.
- Completed outbound calls to patients & Insurance carriers regarding outstanding balances.
- Reviewed claim denials, rejections and take appropriate action.
- Applied federal and state rules and regulations.
- Document account activity in the Patient Accounting system.
Medical Assistant
Liberty Chiro & PT
Jersey City
06.2015 - 03.2019
- Checked patients in and out, scheduled appointments, assisted in positioning patients for x-rays, gathered medical history and perform diagnostic procedures.
- Performed medical billing and coding.
- Ordered medical and office supplies and medications. Stocked exam rooms.
- Assure cleanliness and proper operation of all therapy equipment.
- Measured patent vital signs (pulse, blood pressure, pulse, and temperature), height and weight.
Education
High School Diploma -
Dickinson High School
Jersey City06-2016
Skills
- Organizational skills
- Provider credentialing
- Regulatory compliance
- Claims processing
- Microsoft Office Suite
- Navinet software
- Waystar software
- Amkai software
- Billing and coding compliance
- ECW CBO HUB
- Facets system
- NPPES database
- Sprovider platform
- Insurance verification
- Detail orientation
- Team collaboration
- HIPAA compliance
- Application processing
- Investigation support
- Multitasking ability
- Document review
- Information verification
Languages
Spanish
Professional
Timeline
Provider Enrollment Analyst
Amerihealth Caritas
12.2022 - Current
Billing Administrator
Advantage Behavioral Health
05.2021 - 12.2022
Accounts Receivables
Paths, LLC
12.2020 - 05.2021
Medical Biller
Jefferson Surgery Center
08.2019 - 07.2020
Medical Billing Specialist
Sutherland (Third Party Billing Co)
03.2019 - 08.2019
Medical Assistant
Liberty Chiro & PT
06.2015 - 03.2019
High School Diploma -
Dickinson High School