SOPHIA MANZANARES
Summary
Dynamic and results-driven professional with extensive experience at Cala Health Inc., excelling in claims analysis and billing compliance. Proven track record in process improvement and team leadership, enhancing collections efficiency. Strong analytical skills and exceptional communication abilities drive successful outcomes in complex reimbursement environments. Passionate about delivering outstanding customer service and optimizing financial operations.
Overview
12
12
years of professional experience
Work History
Lead Claims and Billing Specialist II
Cala Health Inc.
San Mateo, CA
02.2021 - Current
- Review and analyze claims for accuracy, completeness, and compliance with insurance policies and regulations.
- All eligibility and benefit investigations.
- Medical records review.
- Follow up with outstanding A/R for all payers, including self-pay, and the resolution of denials.
- Managing and posting payments.
- Set up of EFT/ERN.
- Identify and resolve discrepancies and errors in claims.
- Work on monthly aging reports: research unpaid claims.
- Research and reconcile credit balance accounts and process adjustments as needed.
- Assisted in developing strategies for improving collections processes.
- Assisted with year-end closing tasks including preparing journal entries.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Calculated billing charges prepared and submitted claims to insurance companies.
Financial Coordinator Functional Lead
Happy Healthy Teeth
Foster City, CA
08.2019 - 05.2021
- Successfully converted the office from paper claims to electronic billing.
- Claims follow-up.
- Payment posting.
- Benefit verification and predeterminations.
- Account collections.
- Review and prepare monthly invoices.
- Scheduling
- Ensured accuracy of budget reports and financial statements.
- Provided support to department heads in preparing budget requests.
- Assisted in developing long-term strategic plans based on current performance metrics.
- Identified discrepancies between actual and expected results and investigated underlying causes.
- Reviewed financial documents such as invoices, purchase orders, contracts.
- Reconciled bank accounts on a monthly basis.
- Ensured compliance with applicable laws and regulations related to finance activities.
Lead Reimbursement Specialist
Roche Diagnostics
San Jose, CA
05.2017 - 03.2018
- Provide an exceptional customer service experience.
- Submit both prior and retro authorizations.
- Perform eligibility checks and benefit investigations.
- Comprehensive follow-up on billing and adjudicated claims.
- Contacting healthcare providers and policyholders.
- Analyzed trends in denied claims data in order to improve overall accuracy rate when submitting claims for payment.
- Maintained detailed records of all reimbursements including payments, denials, appeals, and adjustments.
- Developed training materials for new staff on the principles of healthcare reimbursements.
- Reviewed medical documentation to evaluate the accuracy of submitted claims for reimbursement purposes.
- Researched complex billing codes used by third party payers in order to maximize revenue collections from payers.
Manager of Eligibility and Financial Clearance
Natera Inc.
San Carlos, CA
08.2013 - 05.2017
- Work on monthly aging reports.
- Research unpaid claims to determine payor trends.
- Correctly code and bill claims.
- Facilitate the coordination of tasks within and between departments.
- Utilized effective problem-solving and troubleshooting techniques to resolve patient billing errors.
- Conduct accurate data entry of patient-identifiable information.
- Supervise employees and staff members, split between two working groups.
- Coached, mentored and trained team members in order to improve their job performance.
- Ensured compliance with regulatory requirements and industry standards.
- Developed and implemented strategies to increase customer satisfaction and loyalty.
- Assessed team member's skillsets and assigned tasks accordingly for optimal efficiency.
- Streamlined communication channels, improving information flow and decision-making speed.
Education
Skyline College
San Francisco, CASkills
- Strong analytical and problem-solving skills
- Eligibility verification
- Claims analysis
- Billing compliance
- Insurance verification
- Data reconciliation
- Process improvement
- Team leadership
- Attention to detail
- Problem solving
- Billing dispute resolution
- Excellent communication and interpersonal skills
- Attention to detail and accuracy
- Ability to work independently and as part of a team
Timeline
Lead Claims and Billing Specialist II
Cala Health Inc.
02.2021 - Current
Financial Coordinator Functional Lead
Happy Healthy Teeth
08.2019 - 05.2021
Lead Reimbursement Specialist
Roche Diagnostics
05.2017 - 03.2018
Manager of Eligibility and Financial Clearance
Natera Inc.
08.2013 - 05.2017
Skyline College
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