Priscilla Rodriguez

• Acting as subject matter expert (SME) to guide team on complex billing regulations and compliance.
• Monitor aging reports and claim submission.
• Investigate denials and appeals.
• Perform claim edits and charge corrections

• Subject Matter Expert (SME)
• Revenue Cycle Management
• Medical Billing
• BCBS Claims & Appeals
• Denials Management
• Team Leadership
• Staff Training & Mentoring
• Process Improvement
• SOP Development
• Monitor aging reports and claim submission.

Investigate denials and appeals.

• Perform claim edits and charge corrections.
• Assist supervisors with escalations.
• Improved workflows.

• Implemented improvements to streamline refund procedures, enhancing operational efficiency.
• Processed refund requests ensuring compliance with company policies and protocols.
• Reviewed documentation to verify accuracy and legitimacy of refund claims.
• Collaborated with cross-functional teams to resolve discrepancies in refund processes.
• Implemented effective scheduling strategies, optimizing staff coverage during peak business hours.
• Mentored junior team members, fostering a supportive and collaborative work environment.
• Identified customer service trends to provide recommendations for process and procedural improvements.