Rosalba Rosas
Fort Worth,TX
Summary
Reliable professional offering an extensive career promoting positive customer experiences. Sharp Eligibility Specialist boasting expertise in managing and eligibility information for members and groups. Skilled administrative team member with in-depth understanding of medical standards, compliance requirements and operational procedures. Practiced problem-solver with friendly and caring mentality and excellent communication skills. Expertise in inventory management, customer service and inner-office operations. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Insurance Precertification Specialist
Cook Children's Medical Center
Fort Worth, TX
10.2022 - Current
- Completed relevant insurance and other claim forms.
- Ensured compliance with all HIPAA regulations pertaining to protected health information.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
- Entered client information and files into databases for further review and tracking.
- Evaluated clinical criteria against existing health plan guidelines to determine authorization status.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Worked with cross-functional teams to achieve goals.
- Reviewed patient medical records to determine medical necessity for requested services and procedures.
- Managed intake of new claims and performed routine follow-ups.
Medical Receptionist
Cook Children's Medical Center
Fort Worth, TX
02.2020 - 10.2022
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
- Greeted patients, determined purpose of visit and directed to appropriate staff.
- Informed patients of financial responsibilities prior to rendering services.
- Scheduled appointments, optimizing patient satisfaction, provider time and treatment room utilization.
- Delivered high-quality administrative and customer service to sustain patient and work flows.
- Applied knowledge of medical terminology and insurance processes to support office administration productivity.
- Entered insurance, demographics and health history into patient database.
- Scheduled and confirmed patient appointments and consultations.
- Verified insurance coverage for appointments and collected co-payments as required.
- Retrieved faxes and uploaded documents to patient charts to assist clinical staff.
- Gathered, transcribed and typed medical information into charts.
- Communicated with patients with compassion while keeping medical information private.
- Maintained patient accounts by obtaining, recording and updating personal and financial information.
- Answered incoming calls, responding to inquiries from patients and other medical offices.
- Answered multi-line phone system and directed callers to requested personnel and departments.
EVS Housekeeper
Cook Children's Medical Center
Fort Worth, TX
08.2018 - 02.2020
- Requisitioned supplies or equipment for cleaning and maintenance duties.
- Helped prevent spread of infections by sanitizing surfaces, furniture and equipment.
- Wiped down surfaces and refilled soap and hand sanitizer to prevent spread of germs.
- Reviewed daily schedules to plan out cleaning routines and gather needed supplies.
- Followed chemical cleaner and power equipment procedures to prevent damage to floors and fixtures.
- Completed in-depth restroom cleanings to sanitize partitions, decorations, sinks, counters and mirrors.
- Followed safety processes for all manual and electric cleaning equipment.
- Demonstrated excellent customer service skills while interacting with guests and staff members.
- Followed infection control protocols when disposing of used linens and trash bags.
- Followed company uniform, performance and security policies with every job.
- Responded quickly to calls for spills and other potentially dangerous situations.
- Handled, mixed and stored chemical cleaners in compliance with safety requirements and standard operating procedures.
Education
High School Diploma -
Colonial High School
Orlando, FL05-2003
Some College (No Degree) - Criminal Justice
ASA College
Brooklyn, NYSkills
- Documentation and Paperwork
- Knowledgeable in Microsoft Office, EPIC, Parachute
- Medicaid Knowledge
- Appointment Scheduling
- Data Entry
Affiliations
- Fitness Goals; I train 6x a week (very disciplined)
Certification
- BLS
Languages
Spanish
Native/ Bilingual
Timeline
Insurance Precertification Specialist
Cook Children's Medical Center
10.2022 - Current
Medical Receptionist
Cook Children's Medical Center
02.2020 - 10.2022
EVS Housekeeper
Cook Children's Medical Center
08.2018 - 02.2020
High School Diploma -
Colonial High School
Some College (No Degree) - Criminal Justice
ASA College
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