Sonji M. ROSS
Reynoldsburg
Summary
Professional enrollment specialist with strong track record in data analysis and process improvement within enrollment and insurance settings. Proven ability to optimize enrollment procedures and enhance data accuracy, leading to improved operational efficiency. Committed to team collaboration and adapting to evolving organizational needs, known for reliability and results-oriented mindset.
Overview
33
33
years of professional experience
Work History
Claims and Enrollment Analyst
ADAMH
08.2018 - 01.2026
- Performs all aspects of member enrollment and provider claims processing in accordance with established policies and procedures; employing knowledge of service providers' contracts and budgets. Acts as primary contact for assigned providers.
- Responsible for applying analytical thinking and knowledge of provider agency budget and contracts, procedure codes, rate schedule infrastructure, and benefit plans in order to identify system issues.
- Conducts ongoing quality assurance reviews of assigned provider enrollments and claims; conducting follow-up activities with assigned provider and Senior Claims and Enrollment Analyst when necessary.
- Provide technical support regarding enrollment and claims procedures to other ADAMH business units. Responds to request for technical support received via telephone, emails, or helpdesk support tickets for assigned providers.
- Review changes to member eligibility and perform claim re-adjudication as needed to ensure proper payment; solves other problems related to claims pricing when discrepancies arise.
- Analyzed enrollment data to identify trends and improve outreach strategies.
Enrollment Analyst
Nationwide Children's Hospital
03.2017 - 07.2018
- Charged with ensuring proper account information for timely payments.
- Responsible for retrieving status information from government and third-party payers regarding outstanding claims.
- Coordinated with government agencies, third-party payers, and internal auditors to ensure maximum reimbursement for hospital services.
- Acted as a liaison between the hospital and third-party payers in resolving billing and reimbursement.
Senior Customer Service Representative/Provider
Aerotek/ Buckeye Health Plan
08.2015 - 03.2017
- Responsible for answering physicians calls and questions ensuring that all concerns are addressed and resolved in a timely manner.
- Assisted in verifying patient insurance eligibility, benefits, and obtained pre-certifications.
- Ensured that all complaints and claim issues from physician offices and operational departments were resolved per the performance agreement guidelines.
Customer Service Representative
Health Scope Benefits
10.2014 - 08.2015
- Charged with answering and addressing customer service calls from client representatives, members, and providers.
- Ensured that all issues brought forth during phone inquiries were addressed with the appropriate resolution.
- Responsible for establishing and maintaining professional rapport with clients and providers; hospitals and physicians.
- Planned and assisted in on the job training for new members.
- Working knowledge of CPT-4 coding, ICD9, and overall medical terminology.
Medical Records Office Assistant
The Ohio State Medical Center
02.1999 - 08.2005
Patient Care Assistant
The Ohio State Medical Center
06.1993 - 02.1999
Education
High School Diploma -
Linden McKinley High School
Columbus, Ohio01-1985
Skills
- Problem-solving
- Enrollment management
- Policy interpretation
- Analytical thinking
- Confidentiality and professionalism
- Attention to detail
- Report generation
Timeline
Claims and Enrollment Analyst
ADAMH
08.2018 - 01.2026
Enrollment Analyst
Nationwide Children's Hospital
03.2017 - 07.2018
Senior Customer Service Representative/Provider
Aerotek/ Buckeye Health Plan
08.2015 - 03.2017
Customer Service Representative
Health Scope Benefits
10.2014 - 08.2015
Medical Records Office Assistant
The Ohio State Medical Center
02.1999 - 08.2005
Patient Care Assistant
The Ohio State Medical Center
06.1993 - 02.1999
High School Diploma -
Linden McKinley High School