Sergia M Ventura
Garfield
Summary
Dynamic Insurance Verification Representative with proven success at Med Metrix in enhancing patient care through efficient pre-authorization processing and meticulous claims management. Skilled in HIPAA compliance and data entry, I excel in customer service and collaboration, consistently meeting performance metrics to drive client satisfaction and operational excellence. Demonstrated expertise in streamlining verification processes and reducing claim denials. Exhibited excellent analytical skills and attention to detail in fast-paced environment.
Overview
17
17
years of professional experience
Work History
Insurance Verification Representative (Remote)
Med Metrix
06.2023 - Current
- Verified insurance eligibility and coverage for diverse patient populations.
- Processed pre-authorization requests efficiently to ensure timely patient care.
- Collaborated with healthcare providers to resolve discrepancies in insurance information
- Use Excel for verification logs, high-risk reporting, and productivity tracking.
- Utilized electronic health record systems to maintain accurate patient data.
- Update patient accounts and insurance information on EPIC.
- Collaborate with schedulers and clinical teams to prevent claims delay.
- Maintain strict HIPPA compliance and documentation accuracy.
- Contributed to company growth by consistently meeting performance metrics for speed, accuracy, and client satisfaction in the insurance verification process.
Account Resolution Specialist
Prime Healthcare - St. Mary's General Hospital
02.2021 - 06.2023
- Managed commercial, Medicaid, Medicare, and Out-of-state accounts.
- Submitted technical appeals for incorrect or underpaid claims.
- Processed correspondence and update patient accounts,
- Resolved COB issues and updated insurance details.
- Handled DRG downgrade appeals through the required levels.
- Monitored account statuses, prioritizing high-impact cases for timely resolution.
- Analyzed trends in billing disputes to identify root causes and recommend solutions.
Secretary
King Of Dents LLC
07.2020 - 01.2021
- Managed scheduling and coordination of appointments for multiple executives, ensuring optimal time management.
- Developed and maintained filing systems to enhance document retrieval efficiency and organization.
- Implemented office procedures that improved overall workflow and reduced processing times.
- Prepared meeting notes, agendas, and internal documents.
- Provided exceptional customer service by promptly addressing inquiries and resolving issues professionally.
Sales Associate
Macy's
12.2013 - 04.2014
- Assisted 60+ customers daily with product information.
- Created displays to increase sales and reduce overstock.
- Stayed current on promotions, policies, and and security standards.
- Collaborated with team to exceed sales goals consistently.
- Delivered exceptional customer service to enhance shopping experiences and drive repeat business.
Receptionist
Wireless Innovations LLC.
05.2009 - 03.2011
- Managed multi-line phone system, directing calls to appropriate departments efficiently.
- Coordinated scheduling for meetings and appointments, optimizing office calendar management.
- Assisted clients with inquiries, providing exceptional customer service and support.
- Streamlined front desk operations, enhancing workflow and reducing wait times for visitors.
Education
No Degree - Psychology
Caldwell University
Caldwell, NJ06-2013
High School Diploma -
John F. Kennedy High School
Paterson, NJ06-2007
Skills
- HIPAA compliance
- Claims processing
- Data entry and review
- Coordination and scheduling
- Work monitoring
- Proficient in Word, Excel, One note, Outlook, Epic, and SharePoint
- Follow-up skills
- Customer service
Timeline
Insurance Verification Representative (Remote)
Med Metrix
06.2023 - Current
Account Resolution Specialist
Prime Healthcare - St. Mary's General Hospital
02.2021 - 06.2023
Secretary
King Of Dents LLC
07.2020 - 01.2021
Sales Associate
Macy's
12.2013 - 04.2014
Receptionist
Wireless Innovations LLC.
05.2009 - 03.2011
No Degree - Psychology
Caldwell University
High School Diploma -
John F. Kennedy High School