Summary
Overview
Work History
Education
Skills
Timeline
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Sonia Flores

Sacramento,CA

Summary

Dedicated professional with knowledge of great customer service with both the Patient, Payer , and Organization. Passionate about my work and applying my skills to resolve all issues related to my job duties.

Overview

15
15
years of professional experience

Work History

Account Follow Up Represenative

R1 Rcm
11.2022 - Current
  • Follow up on claims, authorizations, denials, and appeals.
  • Appealing authorizations and claims per contract terms and contract language.
  • Submitting retro authorizations.
  • Contributed to team objectives in fast-paced environment.
  • Utilize my time to meet personal and Team goals.

Team Member, Claims II

Sutter Shared Services
03.2019 - 10.2022
  • High dollar to low claims review. Appealing claims and authorizations at the claim level.
  • Review and submitting retro authorization.
  • Adjusting claims per EOB and or expected reimbursement.
  • Research as to why the claim is denied and or underpaid.

Senior Resolution Team Member

Sutter Shared Services
05.2017 - 02.2019
  • Demonstrated knowledge of company mission and goals and mentored employees in reaching objectives aligned with company core values.
  • Provided training and support to onboarding employees.
  • Created detailed reports on team's progress.
  • Responsible for tracking and proving payer issues to Team Lead, other Teams, and Payer Relations.
  • Working wit my Team in a positive matter and to motivate others to do their best.

Government Team Member

Sutter Shared Services
03.2016 - 04.2017
  • Work only high dollar accounts with a claim denial for resolution and payment.
  • Assess action needed to resolve denials, such appeal, adjustment, or write off the balance.
  • Review contracts to determine if the Payer paid the claim correctly.
  • Contact the payer via phone or web site for more detailed information on the claim or to resolve the claim.

Non Government Collections Lead

Sutter Health Sac Sierra Region
02.2014 - 01.2016
  • Responsible for training new staff and acquiring system access needs.
  • Reports to and aids the Supervisor in status and management of current staff.
  • Worked with other work areas with account resolutions.
  • Maintaining a professional matter at all times.

HMO/PPO Collections Represenative

Sutter Health Sac Sierra Region
12.2008 - 01.2014
  • Responsible and successful for managing and prioritizing collection and denials on HMO and PPO accounts to stay within the AR goals.
  • Tracking and reporting Payer issues to Specialist, Supervisor, and Contract Liaisons.
  • Assist with new hire training.

Education

High School Diploma -

Hiram W. Johnson High School
Sacramento, CA
06.1992

Skills

  • Government Regulations
  • Problem Identification
  • Customer Engagement
  • Account Reconciliation
  • Communication
  • Documentation
  • Prioritization

Timeline

Account Follow Up Represenative

R1 Rcm
11.2022 - Current

Team Member, Claims II

Sutter Shared Services
03.2019 - 10.2022

Senior Resolution Team Member

Sutter Shared Services
05.2017 - 02.2019

Government Team Member

Sutter Shared Services
03.2016 - 04.2017

Non Government Collections Lead

Sutter Health Sac Sierra Region
02.2014 - 01.2016

HMO/PPO Collections Represenative

Sutter Health Sac Sierra Region
12.2008 - 01.2014

High School Diploma -

Hiram W. Johnson High School

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Sonia Flores