Ricdette Almestica
Orlando,Florida
Summary
Accomplished bilingual Healthcare Professional with expertise in copay programs and insurance eligibility verification. Proficient in managing heavy caseloads, ensuring compliance with daily metrics, and delivering exceptional customer service. Skilled in PAP copay assistance, claims billing (1500), COB/EOB review, and appeal submissions. Aspiring to leverage case management experience to enhance patient support and operational efficiency.
Overview
16
16
years of professional experience
Work History
Patient Access Coordinator (Benefit Verification)
Elevance Healthcare
10.2017 - Current
- Ensured patient eligibility verification prior to medication approval submissions.
- Obtained all necessary medical documentation to prevent authorization denials.
- Communicated status updates on authorization requests to patients and physicians.
- Reviewed live claim rejections and admitted approved claims for further evaluation.
- Guided patients on Medicaid enrollment and PAP assistance eligibility processes.
A3I Medtronic
Case Management
05.2014 - 08.2016
- Secured timely medical benefits for durable medical equipment (DME) approvals.
- Facilitated approval processes for spinal cord stimulators and pain pumps.
- Provided financial counseling and assistance for copay support to patients.
- Supported physicians with appeals for denied authorization requests.
- Ensured all necessary medical documentation was submitted for approval.
Front Office Coordinator
Ability Health and Rehabilitation
01.2012 - 10.2014
- Enhanced patient experience by efficiently managing front desk operations.
- Ensured accurate financial transactions by collecting copayments and processing payments.
- Validated patient insurance and secured Letters of Protection for litigation cases.
- Maintained office supply inventory, ensuring availability for daily operations.
CLLS (Lending Specialist)
Advance America
03.2010 - 01.2012
- Assisted clients in understanding loan options and terms.
- Supported processing of payday loan applications to ensure compliance with regulations.
- Educated clients on various lending products available, guiding them towards best decisions suited for their financial needs.
- Ensuring banks deposits are made daily as instructed.
Education
High School Diploma -
Lake Howell High School
Winter Park 05-2012
No Degree - Certified Medical Assistant
Winter Park Tech
Winter Park 05-2010
Skills
- Insurance eligibility verification
- Copay Assistance
- Explanation of benefits
- Prior Authorization Benefits
- Hub services (Onco Hub)
- Customer service Administration
- HIPPA & Compliance
- Microsoft (Excel Outlook word)
Languages
Spanish
Full Professional
English
Native or Bilingual
Timeline
Patient Access Coordinator (Benefit Verification)
Elevance Healthcare
10.2017 - Current
A3I Medtronic
Case Management
05.2014 - 08.2016
Front Office Coordinator
Ability Health and Rehabilitation
01.2012 - 10.2014
CLLS (Lending Specialist)
Advance America
03.2010 - 01.2012
High School Diploma -
Lake Howell High School
No Degree - Certified Medical Assistant
Winter Park Tech