Sheila Espinal
Grove City,OH
Summary
Detail-oriented Revenue Cycle Specialist with a systematic nature and good grasp of billing processes. Successful planner and problem-solver. Ready to apply 11 years' experience and take on a challenging role.
Overview
24
24
years of professional experience
Work History
Paraprofessional Aide
Southwestern City School District
05.2016 - Current
- Keep resources in clean and working fashion to maintain availability for use.
- Organize library equipment and collections.
- Teach group and individual instruction sessions to impart knowledge of library and research practices.
- Organize library media supplies, main catalog, special equipment and permanent records.
- Maintain first-rate service by quickly repairing or replacing damaged materials and equipment according to library budget.
- Reshelve books to maintain neat and tidy reading area.
- Maintain complete and accurate records of library transactions.
- Process faculty requests for new resources.
- Support students throughout academic instruction and assignments.
- Provide classroom support throughout planned instruction and individual lessons.
Revenue Cycle Specialist
OSU Wexner Medical Center
03.2007 - 05.2016
- Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Compiled and coded patient information or data in appropriate computer system.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Communicated with patients with compassion while keeping medical information private.
- Offered patients information and assistance navigating insurance coverage.
- Recorded information according to insurance company requirements to maximize insurance coverage and reduce patient costs.
- Negotiated with creditors on behalf of clients to arrange for payment adjustments, reductions and time extensions.
- Entered client information and files into databases for further review and tracking.
- Managed intake of new claims and performed routine follow-ups.
- Responded to client inquiries and concerns and escalated complex problems to department supervisors.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Reviewed accounts to determine payment plan compliance.
Pre-Certification Specialist
OhioHealth Group
05.2005 - 03.2007
- Offered administrative task assistance and performed database updates, email communication and document processing.
- Accessed programs and set up correct payment strategies based on patient means and needs.
- Processed cash, debit and credit card payments for services rendered and printed receipts detailing services.
- Registered patients for outpatient procedures and emergency services.
- Carefully checked insurance information for benefits coverage and input pre-authorization documents into system.
- Maintained HIPAA compliance and integrity of hospital policies and procedures.
- Contacted insurance carriers to verify coverage, copays and deductible information for patients.
Medical Claims Examiner
Great West Health Care
07.2000 - 05.2005
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Sent clinical request and missing information letters to obtain incomplete information.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
Education
High School Diploma -
Westland High School
Galloway, OH06.1996
Skills
- Insurance collaboration
- Claims review
- Records coordination
- Problem resolution
- Organizational skills
- Good work ethic
- Patient interviewing skills
- Policy adjustment knowledge
Timeline
Paraprofessional Aide
Southwestern City School District
05.2016 - Current
Revenue Cycle Specialist
OSU Wexner Medical Center
03.2007 - 05.2016
Pre-Certification Specialist
OhioHealth Group
05.2005 - 03.2007
Medical Claims Examiner
Great West Health Care
07.2000 - 05.2005
High School Diploma -
Westland High School
Similar Profiles
Katelyn HughesKatelyn Hughes
First Grade Teacher at Southwestern City School DistrictFirst Grade Teacher at Southwestern City School District
Starla BibleStarla Bible
Substitute Teacher at Southwestern City School DistrictSubstitute Teacher at Southwestern City School District
Ramona ChristyRamona Christy
Paraprofessional at Southwestern City School DistrictParaprofessional at Southwestern City School District