Roberta Fuentes
Dallas
Summary
My objective is to obtain a challenging position in the Healthcare Insurance industry to effectively utilize my leadership skills.
A highly competitive and professional individual with proven results of meeting and exceeding company objectives. I provide quality work while striving to achieve established goals.
Overview
27
27
years of professional experience
Work History
Patient Account Representative
Guidehouse
11.2023 - Current
- Assisted colleagues during peak periods or absences, showcasing teamwork skills while maintaining personal workload demands efficiently.
- Posted payments and processed refunds.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.
- Conducted regular audits of patient accounts, identifying discrepancies and rectifying errors as needed.
- Ensured compliance with healthcare regulations while processing claims and managing patient accounts.
- Enhanced patient satisfaction by promptly addressing inquiries and resolving account issues.
CLAIMS EXAMINER
WebTPA
11.2020 - Current
- Responsible for processing of claims medical, and mental health claims
- Responsibilities includes claim processing and adjudication, with claims research where applicable
- Incumbents must meet and/or exceed quality and quantity production standards
- Claims processing ranges in levels of complexity
PFS ASSOCIATE IV- MEDICARE BILLER
CHRISTUS Health
02.2019 - 08.2020
- Responsible for performing billing, collections and reimbursement services of claims and duties to hospitals supported by the RCBS
- In doing so, ensures that all claims billed and collected meets all government mandated procedures for Integrity and Compliance
CLAIMS EXAMINER
CHRISTUS Health
03.2017 - 01.2019
- The Claims Examiner is responsible for processing UB and CMS 1500 claims, performing data entry and claim pend issue resolution within the quality and production requirements
MEMBER SERVICE LEAD
Christus Health
04.2014 - 02.2017
- This position is responsible for the delivery of superior customer service by ensuring calls are answered effectively and efficiently throughout the day
- The primary functions of this role are supervising overall call traffic, processing incoming calls, resolving escalated calls, dispatching supervisory calls, assisting Member Services Representatives with any client related questions and ensuring the Reps' adherence to schedules, policies and procedures
- This position will assist in training new Member Services Representatives on job-specific roles and responsibilities
CUSTOMER SERVICE REPRESENTATIVE
Aetna Life, Retiree Advocate Insurance Inc
07.2012 - 12.2013
- My position consisted of receiving inbound calls from retirees from the Teacher Retirement System for the State of Texas for assistance with their Medicare Advantage coverage needs
- My position required providing excellent customer service to the retiree's while assisting them with any questions regarding their health insurance coverage and claims
PAYMENT PROCESSOR
Santa Fe Auto Insurance
11.2011 - 04.2012
- My position consisted of receiving inbound calls with the purpose of processing monthly payments
- My position required providing excellent customer service to the insured customers by processing payments efficiently and promptly
ACCOUNT CONTROL TECHNOLOGY PORTFOLIO REPRESENTATIVE
Santa Fe Auto Insurance
05.2008 - 07.2009
- My position had the primary mission to ensure to success by initiating outbound calls and receiving inbound calls with the purpose of resolving delinquent and defaulted student loan debt
- My position required aiding borrowers in finding solutions to their financial problems in compliance with federal guidelines
JUVENILE CORRECTIONAL OFFICER
The Geo Group Inc
05.2006 - 10.2007
- Worked with youth in a detention center to ensure their safety, maintain records, and aid in rehabilitation
- I was responsible for always keeping youth offenders under supervision making frequent inspections for weapons or drugs and maintaining order in the facility
C&C TRUCKING SUPERVISOR
The Geo Group Inc
05.2001 - 11.2005
- Accountable for a team of 15-20 agents
- Handled coaching and incentive programs, payroll, and quality assurance - side by side monitors and remote monitors to ensure customer satisfaction, proper company guidelines and procedures
- Managed accurate statistical reports daily
- Implemented team moral and motivating incentives for team members
- Maintained agent schedule adherence to ensure call volumes are met
- Participated in the interview process of new agents
- Conducted corrective action measures for employees not meeting company goals and needs
- Provided direction and guidance on how to meet company goals
- Evaluated employees for annual reviews
- Provided leadership for the team in the areas of problem resolution to assist in customer satisfaction
- Coached direct reports towards individual development
MEMBER SERVICE AGENT
Blue Cross Blue Shield Of Texas
05.1998 - 10.2001
- Receiving inbound calls to assist and support clients in a positive and proactive manner
- Ensured members issues are resolved in a timely manner
- Effectively communicated benefit information to members and participating provider networks
- Investigated and resolved phone inquiries regarding electronic, paper, paid and rejected claims
Education
Angelo State University -
Angelo State University
San Angelo, TX01.1996
San Angelo Central High School -
San Angelo Central High School
San Angelo, TX01.1995
Skills
- Windows Xp
- Powerpoint
- Lotus Notes
- Reading Comprehension
- Deductible Collection
- Data Verification
- Claims Understanding
- Customer Satisfaction
- Coverage Analysis
- Claims Adjustments Review
- Spreadsheet Tracking
- Claims Investigations
- Bilingual-Spanish
- Medical Terminology
- ICD-10
- Limited Lines Critical Thinking
- Claims Processing
- Collections
- Clerical
- Medical Records
- Medical Billing
- Insurance verification
- HIPAA compliance
- Insurance billing
- Medical billing
- Follow-up skills
- Medical Billing Understanding
- Strong empathy
- Data entry proficiency
- Team collaboration
- Medical terminology knowledge
- Verbal and written communication
- Insurance collaboration
Languages
Spanish
Native or Bilingual
Timeline
Patient Account Representative
Guidehouse
11.2023 - Current
CLAIMS EXAMINER
WebTPA
11.2020 - Current
PFS ASSOCIATE IV- MEDICARE BILLER
CHRISTUS Health
02.2019 - 08.2020
CLAIMS EXAMINER
CHRISTUS Health
03.2017 - 01.2019
MEMBER SERVICE LEAD
Christus Health
04.2014 - 02.2017
CUSTOMER SERVICE REPRESENTATIVE
Aetna Life, Retiree Advocate Insurance Inc
07.2012 - 12.2013
PAYMENT PROCESSOR
Santa Fe Auto Insurance
11.2011 - 04.2012
ACCOUNT CONTROL TECHNOLOGY PORTFOLIO REPRESENTATIVE
Santa Fe Auto Insurance
05.2008 - 07.2009
JUVENILE CORRECTIONAL OFFICER
The Geo Group Inc
05.2006 - 10.2007
C&C TRUCKING SUPERVISOR
The Geo Group Inc
05.2001 - 11.2005
MEMBER SERVICE AGENT
Blue Cross Blue Shield Of Texas
05.1998 - 10.2001
Angelo State University -
Angelo State University
San Angelo Central High School -
San Angelo Central High School
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