Sara Rivas
Miami
Summary
Experienced Health Insurance Collector with 8+ years expertise in Medicare and Medicaid HMO's Medicaid Out of State collections. Experience in handling insurance claims and resolving denials, billing issues and/or corrections. I am seeking a challenging position in a reputable healthcare organization to utilize my expertise in insurance collection and contribute to the financial success of the institution.
Professional with strong background in collections, prepared for this role. Adept at resolving outstanding debts and facilitating payments. Strong team collaborator with focus on achieving results and adapting to changing needs. Skilled in negotiation, communication, and conflict resolution. Reliable, efficient, and results-driven with keen eye for detail.
Overview
13
13
years of professional experience
Work History
Government Collector
Mount Sinai Medical Center
03.2017 - Current
- Identified under payments from payors
- Skilled in appeal and/or request rebill denied charges for claim correction resulting in full reimbursement
- Identify and resolve claim discrepancies
- Correctly rejected claims or any other issues that affect reimbursement
- Review correspondence; collaborate with payors to obtain information and ensure proper claim submission
- Follow with physician for Out of state provider enrollment
Account Collector
Larking Community Hosp Palm Springs
02.2016 - 03.2017
- Medicare and Medicaid HMO's collector (Leon, Simply, Preferred and Care Plus)
- Review R/A denials making sure claim process correctly based on contract
- Follow up with appeals, denials, and claims correction
- Submit appeals in a timely manner
- Called / login in to obtain claim status and review processing correctly. Fax records if necessary to obtain maximum reimbursement
Registration
Palm Springs General Hospital
11.2011 - 02.2016
- ER and Outpatient registration. Obtain patient demographic as accurate possible run and verify benefits. Put bracelet to ID patient
- Getting all consents signed including ABN's. Collect any copays or deductible if any applied to patient responsibility at time of service (Not in ER)
Education
GED -
Ponce High School
Ponce Puerto RicoSkills
- Ability to handle a high volume of insurance claims
- Extensive knowledge in medical terminology
- Review and analyze insurance claim for accuracy and completeness avoiding timelines
- Proficient in insurance claim processing, including Medicare, Medicare and HMO's
- Proficient in DDE system, Spot, and Florida Medicaid site
- Knowledge in CPT, ICD-10, and HCPCS coding
- Maintained strict adherence to HIPAA regulations and guidelines, ensuring patient privacy and confidentiality
- Participated in training and professional development activities, staying current with industry changes and best practices
- Aging reports analysis
- Insurance company communication
- Financial documentation
- Follow-up techniques
- Strong negotiation skills
- Goal-oriented mindset
- Data entry proficiency
Languages
Spanish
Full Professional
English
Full Professional
Timeline
Government Collector
Mount Sinai Medical Center
03.2017 - Current
Account Collector
Larking Community Hosp Palm Springs
02.2016 - 03.2017
Registration
Palm Springs General Hospital
11.2011 - 02.2016
GED -
Ponce High School
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