Rosangelica Cruz-Noderer
Phoenix,AZ
Summary
Sharp and talented professional promoting various skills through a career spent successfully tracking data and ensuring accuracy. Looking for a Biller position where poise, an optimistic personality, and commitment to excellence will be highly valued.
Overview
12
12
years of professional experience
Work History
Revenue Cycle Biller
Mountain Health Park Center
Phoenix, Arizona
06.2023 - Current
- Efficiently process billing correspondence and claim charges within the eClinicalWorks system.
- Submit claims to insurers daily and oversee payment functions for Electronic Fund Transfers and paper checks.
- Collect insurance payments, resolve denied and unpaid claims and ensure timely resubmission.
- Request and review additional documentation for claim audits and revenue reporting, including eligibility, benefits, and provider information.
- Perform HCFA, and UB-04 billing, managing collections for Medicare, Medicaid, Managed Care, and Private Pay claims. Conduct daily audits to optimize collections and review Explanation of Benefits (EOBs) for compliance with established billing practices.
Advance Analyst
Centene Corporation
Phoenix, Arizona
08.2020 - 06.2023
- Adjudicated claims through Cenpats and Amisys per Medicaid policies to ensure timely patient services.
- Increased timely processing by conducting detailed analysis on ad hoc projects to meet business needs.
- Conducted testing for workflows and claims processes to ensure compliance with Medicaid guidelines.
- Minimized inventory by 30% through effective utilization of FTC COB and appeals training.
- Facilitated training sessions to guide teammates on various topics, reducing claim inventory and boosting morale.
- Established monthly engagement meetings to enhance team chemistry, confidence, and communication.
- Created bi-weekly PowerPoint presentations for team huddles to review production metrics and departmental goals.
Patient Account Coordinator 1
Preferred Homecare
Phoenix, AZ
08.2019 - 08.2020
- Communicated with insurance companies regarding eligibility, claim status, and follow-up denials to ensure timely claim submission.
- Verified, adjusted, and updated Accounts Receivable (A/R) according to correspondences received from insurances like Rocky Mountain Health Plan, Denver Health Medicaid, CO Access & Colorado Medicaid.
- Handled patient collections inquiries to gather necessary information for claim completion.
- Manually submitted secondary claims through the government portal for Colorado Medicaid.
- Researched credit balances and initiated refunds, reducing outstanding balances.
HCA/HCIC Processor
Health Choice
02.2016 - 03.2019
- Adjudicated over 1500 COB pended claims in a timely manner in order to avoid payment delays.
- Comply with HCA policies and guidelines to adjudicate electronic/paper claims accurately.
- Analyzed migration of Medmc to QXNT to ensure accurate processing per HCA guidelines.
- Trained in 1500's across various places of services and specialties, including UB HOP claims, to support claims inventory management.
Medical Billing Specialist
Fast Service Billing
07.2014 - 02.2016
- Processed over 500 EOBs during month-end, delivering timely accounts receivables data to clients.
- Submitted client claims in a timely manner by collaborating with insurance companies to ensure proper reimbursement and maintaining company compliance.
- Created payment identification numbers for EOBs using eClinicalWorks and Altapoint, reducing ramp time and payment errors.
- Provided excellent customer service via telephone to patients inquiring about submitted claims with clear communication easing the patient’s concerns.
- Transferred system data for newly acquired clients into new system, minimizing data redundancy and operational inefficiencies.
Education
Diploma - Medical Billing and Coding
Brookline College
Phoenix, AZ07.2014
Diploma - General Studies
Cesar Chavez High School
Phoenix, AZ05.2012
Skills
- Revenue cycle management
- HCFA billing
- Claims adjudication
- Insurance verification
- Patient billing
- eClinicalWorks
- Electronic fund transfers
- Medicaid billing
Timeline
Revenue Cycle Biller
Mountain Health Park Center
06.2023 - Current
Advance Analyst
Centene Corporation
08.2020 - 06.2023
Patient Account Coordinator 1
Preferred Homecare
08.2019 - 08.2020
HCA/HCIC Processor
Health Choice
02.2016 - 03.2019
Medical Billing Specialist
Fast Service Billing
07.2014 - 02.2016
Diploma - Medical Billing and Coding
Brookline College
Diploma - General Studies
Cesar Chavez High School