ROSE KAISER
Hialeah,Florida
Summary
Dedicated Medical Claims Analyst and Process Improvement Specialist with over 15 years of experience in the healthcare industry. Proficient in a variety of software systems, including Microsoft Office Suite and specialized medical billing platforms such as TMA/TMS, NextGen, and Waystar. Demonstrated expertise in major insurance carriers, medical terminology, CPT and ICD coding, and regulatory compliance.
Recognized for strong analytical and problem-solving skills, with a proven track record of identifying inefficiencies and implementing strategic process improvements that enhance operational performance. Committed to delivering exceptional customer service and fostering collaborative relationships with healthcare providers, payers, and internal teams. Results-driven and focused on achieving organizational goals through effective data research, validation, and continuous improvement initiatives.
Overview
15
15
years of professional experience
Work History
Sr. Process Improvement Specialist
Vohra Wound Physicians
05.2017 - Current
- Troubleshoot escalated claims issues, multi-task, and prioritized claims and correspondence responsibilities by age, complexity, and urgency
- Improved revenue cycle throughout the organization, by working with appropriate departments, payers, and vendors to aid in the resolution of identified revenue cycle issues
- Collaborated with cross-functional teams to design and implement RPA solutions to automate repetitive tasks and streamline AR processes
- Identified and developed specialty specific best practices to enhance RCM processes
- Analyzed current AR processes and identified areas for improvement to increase efficiency and accuracy
- Created Standard Operating Procedures to include specific workflows and needs to ensure smooth revenue cycle
- Provided training, problem solving, solution management, and daily monitoring and communication with designated super users
- Analyzed trends to isolate problematic billing issues requiring improvement
- Identified manual processes that could be automated and produce 'Process Definition Document'.
Sr. Collections Specialist for Multi-Specialty Cardiology Group
Integrated Healthcare Administration
06.2015 - 05.2017
- Aggressively collected outstanding insurance payments and submitted disputes for denied/ underpaid claims
- Prepared patient accounts for direct internal collections and external collections with private collections agency
- Assisted both entities in resolving outstanding balances
- Reconciled aging and problem claims/accounts and recommended appropriate actions to be taken
- Conducted thorough research to address patient and insurance company payment issues
- Researched and rectified any insurance/ patient payment discrepancies
- Managed daily collections operations by organizing, planning, and prioritizing workload, performing administrative activities, training, and developing new/established staff members
- Resolved patient/insurance concerns, complaints and inquiries demonstrating analytical problem solving while utilizing great customer service skills.
Collections Specialist for Multi-Specialty Physicians' Practice
Healthworx
06.2009 - 05.2015
- Carried out a variety of processes related to the collection of bills from patients and/ or medical insurances
- Managed Commercial and Government funded accounts: their A/Rs, claims processing and payments
- Served as a liaison with collections agencies
- Worked closely with outside agencies and patients on bad debt accounts
- Performed various administrative tasks
- Print, mail and/ or fax claim forms and statements as requested by patient, insurance companies or other authorized third parties
- Communicate with patients, Physicians, and Insurance companies to resolve accounts, including issues identified through incoming correspondences
- Process and reconcile daily credit card transactions
- Identify payment posting errors and correct as needed
- Transferred patient credits to outstanding balances.
Education
Medical Coding & Billing Specialist -
Florida Career College
12.2007
High School Diploma -
Barbara Goleman Senior High
08.2004
Skills
- Bilingual Communication
- Technical Proficiency
- Insurance Expertise
- Medical Coding Knowledge
- Analytical Skills
- Complex Problem-Solving
- Results-Driven
- Data Research and Validation
- Project Management
- Regulatory Compliance
- Training and Development
- Time Management
- Customer Service Skills
- Attention to Detail
- Workflow Automation
- Strategic Thinking
References
Available upon request.
Timeline
Sr. Process Improvement Specialist
Vohra Wound Physicians
05.2017 - Current
Sr. Collections Specialist for Multi-Specialty Cardiology Group
Integrated Healthcare Administration
06.2015 - 05.2017
Collections Specialist for Multi-Specialty Physicians' Practice
Healthworx
06.2009 - 05.2015
High School Diploma -
Barbara Goleman Senior High
Medical Coding & Billing Specialist -
Florida Career College
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