Rita Lugo
Mesa,AZ
Summary
Experienced professional with a proven track record of achieving company objectives through efficient and organized practices. Adapts quickly to new situations and challenges, consistently enhancing organizational brand.
Overview
21
21
years of professional experience
Work History
Sr. Reinsurance Finance Analyst
Arizona Complete Health, Care1st Health Plan of AZ
10.2018 - 11.2024
- Developed and implemented procedures for reconciliation process to ensure timely completion of monthly reconciliations
- Assisted with month-end closing processes by preparing various reconciliations including balance sheet accounts
- Researched and prepared accounts for all reconciling items on a periodic basis
- Conducted extensive research into customer accounts as needed to resolve outstanding issues
- Provided support in responding to inquiries from internal departments regarding account balances or transaction details
- Engages in membership eligibility research, requiring critical thinking skills and the ability to analyze and resolve payment discrepancies
- Assisted in providing management with weekly and monthly established financial indicators
- Develops relationships with key members of other departments to communicate errors/issues in a timely manner
- Assists with design/requirements and performs testing on new releases of internal applications
- Reviewed financial documents and records to assess accuracy and compliance with applicable laws, regulations, and standards
- Assisted with downloading medical records through Trucare
- Identified discrepancies in financial data and recommended corrective actions to resolve them
- Collaborated with other departments to ensure accurate budgeting and forecasting processes were followed
- Assist with checks, tracking, numbering, and entering the Finance Database
- Pulling, scanning, and mailing checks and letters out to providers
- Researching claims, tracking payments in TI Portal, SFTP, PMMIS, and Encounter databases daily
- Compiled data, reports and year-end audit information.
Lead Member Service Representative
Care1st Health Plan of AZ
03.2008 - 10.2018
- Lead member service rep responsible for monitoring MSR while taking calls and completing other responsibilities in a timely manner
- Responsible for demonstrating excellent customer service skills to both internal and external customers in a prompt, accurate, courteous, and professional manner
- Assists with a variety of departmental office tasks including suspended claims, assist in member billing, credentialing, checking grievances, filing, sorting incoming mail, preparing outgoing mailings and assisting other staff as needed
- Assists in preparation of daily, weekly, monthly, and quarterly reports using Excel, Access, Word
- Responsible for creating, preparing, completing, and tracking lists for daily or weekly items such as member welcome packets and member ID cards
- Preparing member reimbursement forms for the Care1st PBM, CVS Caremark (Pharmacy Benefit Manager) to ensure that payments are made
- Responsible for building member files or correcting member information in the PBM data system when necessary
- Responsible for running daily reports on enrollments and making necessary corrections to the member database
- Responsible for accurate, complete, and correct documentation into the data system regarding all issues and/or inquiries
- Responsible for entering or correcting information regarding creditable coverage of other insurance in member database
- Attending all education and training sessions, mandatory staff meetings and to assist with the training of new employees
- Consistently met or exceeded established performance metrics, contributing to the overall success of the team and organization.
Member Services Representative
Care1st Health Plan of AZ
10.2005 - 03.2008
- Able to effectively communicate verbal/written and work as team member with all associates
- First-line contact with plan members and medical professionals; answered calls regarding plan benefits/eligibility for members as well as medical professionals
- Responsible for assisting in processing all member transportation requests within 24 hours of receipt
- Always maintain all phone protocol and etiquette as well as professional image
- Follow-up and completion of any grievance filed by plan member
- Responsible for maintaining respect for member confidentiality and privacy at all time
- Assist Claims Department as needed to maintain department current
- Processing UB claims/data entry while maintaining an organized professional environment
- Experience in CPT and ICD-9 codes and understanding of Medicaid/Medicare guidelines
- Able to be a team player in both Member Services Dept and Claims Dept by maintaining open effective communication
Medical Billing Externship
Prehab of Arizona
01.2004 - 01.2005
Education
Medical Billing and Coding Specialist - Billing/Coding
Lamson College
Tempe, AZ01.2005
Skills
- Time management
- Excel
- Word
- Outlook
- PowerPoint
- Member billing
- Credentialing
- Dedication
- Knowledge expansion
- Claims Specialist training
- Quick learner
- Customer service standards
Certificates And Awards
- HIPAA Certified
- CPR Certified
Timeline
Sr. Reinsurance Finance Analyst
Arizona Complete Health, Care1st Health Plan of AZ
10.2018 - 11.2024
Lead Member Service Representative
Care1st Health Plan of AZ
03.2008 - 10.2018
Member Services Representative
Care1st Health Plan of AZ
10.2005 - 03.2008
Medical Billing Externship
Prehab of Arizona
01.2004 - 01.2005
Medical Billing and Coding Specialist - Billing/Coding
Lamson College
Similar Profiles
Desiree CalderaDesiree Caldera
PDR Data entry clerk at Care1st Health PlanPDR Data entry clerk at Care1st Health Plan
Kirby Madison-Key LPNKirby Madison-Key LPN
LPN-Concurrent Review Nurse I at Centene-AZ Complete HealthLPN-Concurrent Review Nurse I at Centene-AZ Complete Health
LaTonya Clarke, LPNLaTonya Clarke, LPN
Clinical Operations Analyst/Authorization Coordinator at Sentara Health Plan/Virginia Premier Health PlanClinical Operations Analyst/Authorization Coordinator at Sentara Health Plan/Virginia Premier Health Plan