RUBY CARRETO
Houston,TX
Summary
Experienced with assisting clients in navigating insurance policies and claims. Utilizes communication and problem-solving skills to resolve customer issues efficiently. Track record of enhancing customer satisfaction through thorough policy understanding and effective support, all while upholding HIPAA policies and regulations.
Overview
10
10
years of professional experience
Work History
Medical Insurance Customer Service Representative
UST Healthproof
Aliso Viejo, CA
09.2024 - 02.2026
- Work from home.
- Follow HIPAA regulation to protect health information.
- Processed ROI.
- Prior authorizations.
- Claim appeals.
- Premium billing
- Educated clients on coverage options, ensuring understanding of terms and medical benefits.
- Processed claims efficiently, maintaining accuracy in documentation and follow-up communications.
- Provided exceptional customer support by resolving inquiries and managing policy-related issues.
- Analyzed customer feedback to identify areas for service improvement and implement solutions.
Workers Comp Managed Care Case Management Assistant
Dynamic
Houston, TX, USA
12.2023 - 05.2024
- Work from home.
- Support Nurse Case Managers in updating documentation with respect to provider contact, ancillary service coordination and collecting additional information, as needed
- Validate requests for authorization are complete
- Requests medical records and additional data from requesting physician, if necessary
- File and serves medical reports
- Contact providers, applicant attorneys, and ancillary providers for updated status reports or to answer questions directed from the case managers
- Manage the case management inbox for all case management referrals to AMC and outside vendor partners, as appropriate
- Track all referrals, AMC and vendor partners included
- Complete other projects and tasks as assigned by management
- Direct questions to nursing staff, as needed
- Follow all regulatory policies and procedures, privacy and security standards in accordance with government agencies including HIPAA requirements
- Other duties as assigned
Epic MyChart- Patient Support Work From Home.
CTG
Houston, TX, USA
01.2022 - 07.2023
- Provide MyChart Patient Portal support to patients with activation of their account, resetting of passwords, navigation of the MyChart portal.
- Provide Tier 1 support of MyChart issues reported by the patient community.
- Thoroughly document each issue in the ticketing system accurately and effectively to ensure seamless communication between departments.
- Assessing and responding to calls and requests for assistance
- Troubleshooting, resolving, or escalating incidents in an efficient and effective manner
- Using a technical knowledge base and processing information quickly
- Solving familiar and unfamiliar issues
- Entering accurate and timely data into ServiceNow
- Creating timely and accurate documentation of steps taken and outcomes
- Learning additional support skills for new applications as needed
- Providing and maintaining expert-level knowledge of Epic software
- Provide effective customer service and team support
ER Patient Access Rep/ Insurance verification specialist
First Texas Hospital
Houston, TX, USA
01.2016 - 01.2020
- Greeting and checking patients in and out of ER Dep.
- Admitting patients into hospital
- Collect/update patient demographics and insurance information in HER system
- Verify insurance information, co-payments, deductibles and out of pocket for new/stablished patients, referrals and prior authorizations.
- Update insurance information for existing patients
- Call to obtain pre-authorization for recommended services and procedures
- Explain to patients what their financial responsibilities will be
- Inform relevant clinical staff about denials
- Answer questions related to billing and insurance
- Collected payments for self-pay patients and copays for insured patients
- Updating, filing and maintaining patient medical records in their respective MRN
- Follow all regulatory policies and procedures, privacy and security standards in accordance with government agencies including HIPAA requirements.
Education
GED -
11.2009
AAS degree - Health Information Technology
DeVry University
04.2022
Billing and coding certification - undefined
DeVry University
12.2020
Skills
- Epic
- Centricity
- Collaborate
- Athena
- Review stat
- SIMS
- Evident
- T-systems
- Medicare
- Medicaid
- Tricare
- BCBS
- Aetna
- Cigna
- United Healthcare
- Faxing
- Scanning
- Multiline phones
- Microsoft software's
- Zoom
- Teams
- Data entry
- Call center
- HIPAA compliant
- Scheduling
- ICD-10CM
- ICD-10CPS
- CPT
- Medical terminology
- Medical records management
- ROI
- Referrals
- Prior authorization
Languages
English
Spanish
Timeline
Medical Insurance Customer Service Representative
UST Healthproof
09.2024 - 02.2026
Workers Comp Managed Care Case Management Assistant
Dynamic
12.2023 - 05.2024
Epic MyChart- Patient Support Work From Home.
CTG
01.2022 - 07.2023
ER Patient Access Rep/ Insurance verification specialist
First Texas Hospital
01.2016 - 01.2020
AAS degree - Health Information Technology
DeVry University
Billing and coding certification - undefined
DeVry University