Summary
Overview
Work History
Education
Skills
Timeline
Generic

Pauleetta Rendon

Tampa,Florida

Summary

Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.

Overview

19
19
years of professional experience

Work History

Finance Specialist

USF Health
Tampa, Florida
08.2023 - Current
  • Assessed eligibility of patients for health insurance coverage based on policy guidelines.
  • Investigated discrepancies in customer accounts to determine root cause and resolution.
  • Maintained database of insured members, including demographic information and plan details.
  • Processed incoming referral requests for medical services and submitted them to the appropriate insurance companies for authorization.
  • Assisted patients in understanding their insurance coverage and answered questions about referrals, authorizations, and other related issues.
  • Maintained detailed records of all patient referrals, including dates of submission, status updates, and any additional information required by insurance providers.
  • Coordinated with provider offices to ensure timely completion of referrals prior to scheduled appointments.
  • Follow HIPAA Laws and regulations

Referral Specialist

Cigna/ evicore
Tampa, Florida
07.2022 - 08.2023
  • Generated Referral / Pre Authorizations
  • Processed incoming referral requests for medical services and submitted them to the appropriate insurance companies for authorization.
  • Maintained detailed records of all patient referrals, including dates of submission, status updates, and any additional information required by insurance providers.
  • Coordinated with provider offices to ensure timely completion of referrals prior to scheduled appointments.
  • Answered incoming calls from customers and providers and assisted with referral/Authorization status.
  • Follow HIPAA Laws and regulations

Enrollment Specialist/ Intake Representative

MPF Federal
Tampa, Florida
11.2019 - 06.2022
  • Initiated Enrollment application to participate in the VACCN network.
  • Collect Providers personal and group NPI and TIN
  • Handled new enrollments by entering customers' data and reviewing
    information.
  • Completed accurate and efficient data entry and database updates to
    support business operations.
  • Identified, corrected and reported data entry errors.
  • Provided status of the enrollment application to providers.
  • Planned and conducted investigations of claims to confirm coverage and compensability.
  • Investigated and analyzed requirements to improve timeliness of reports to customers.
  • Provided claim information to VA representatives and Providers
  • Located referrals and provided referral information to providers
  • Follow HIPAA Laws and regulations

Customer Service/ Collections

KLCA Chartered Accountants
Tampa, Florida
12.2016 - 06.2019
  • Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
  • .Notified customers of delinquent accounts with attempt to collect
    outstanding amounts.
  • Processed payments over phone and set up recurring drafts.
  • Recorded and updated customer personal accounts with accurate contact information.

Dental Assistant

Family Dental Group Kumar Rama
Hyattsville, MD
01.2011 - 12.2016
  • Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
  • Provided chair-side assistance during dental examinations and procedures to boost efficiency and calm nervous patients.
  • Sanitized equipment, cleaned treatment rooms and restocked supplies after each patient's treatment to maintain cleanliness and prepare for next patient.
  • Took bitewing, periapical, panoramic and occlusal X-rays and prepared for dentists to review.
  • Educated patients on treatment procedures and post-procedure home care.
  • Updated patient and insurance data and input changes into company
    computer system.

Cashier

Lowes Home Improvment
Gaithersburg, MD
01.2005 - 01.2009
  • Operated cash register or POS system to receive payment by cash, check and credit card.
  • Delivered high level of customer service to patrons using active listening
    and engagement skills.
  • Collected payments and provided accurate change.
  • Helped customers find specific products, answered questions and offered

Education

High School Diploma -

Albert Einstein High School
Kensington, MD
05-2005

Some College (No Degree) - Nursing

Keiser University
Fort Lauderdale, FL

Skills

  • EPIC Proficient
  • Anatomy and Physiology Terms
  • Accurate Documentation
  • Multi-Line Phone Proficiency
  • Insurance Precertification Processes
  • Data Entry Software
  • Bilingual: Fluent in Spanish and English
  • Webex, Citrix, Outlook, Excel, Word
  • ICD 10/ 9 codes
  • HIPAA Compliance
  • Medical Terminology (some)

Timeline

Finance Specialist

USF Health
08.2023 - Current

Referral Specialist

Cigna/ evicore
07.2022 - 08.2023

Enrollment Specialist/ Intake Representative

MPF Federal
11.2019 - 06.2022

Customer Service/ Collections

KLCA Chartered Accountants
12.2016 - 06.2019

Dental Assistant

Family Dental Group Kumar Rama
01.2011 - 12.2016

Cashier

Lowes Home Improvment
01.2005 - 01.2009

High School Diploma -

Albert Einstein High School

Some College (No Degree) - Nursing

Keiser University

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Pauleetta Rendon