SORAYDA ROSA
OCALA,FL
Summary
Driven healthcare professional with hands-on experience in revenue recovery and insurance follow-up, adept at identifying and resolving clinical and medical necessity denials. Skilled in documentation, appeals, and ensuring HIPAA compliance. Seeking a Revenue Cycle Specialist role to leverage expertise in accounts receivable and payer relations to streamline reimbursement processes and enhance overall revenue cycle efficiency.
Overview
1
1
Certification
21
21
years of professional experience
Work History
Revenue Recovery Specialist
Knowtion Health
05.2022 - Current
- Manage high-volume hospital clinical denials for inpatient and outpatient claims
- Perform detailed insurance follow-up with commercial, Medicare, and Medicaid payers
- Identify root causes of denials including medical necessity, authorization, coding, and timely filing
- Prepare and submit first-level and follow-up appeals with complete clinical documentation
- Upload and attach medical records through payer portals (Availity, plan portals)
- Communicate with insurance carriers to obtain claim status, appeal outcomes, and payment determinations
- Ensure appeals meet payer-specific guidelines and deadlines
- Document all claim activity, follow-ups, and outcomes accurately within internal systems
- Collaborate with internal teams to support maximum reimbursement recovery
- Maintain compliance with HIPAA and hospital billing standards while meeting productivity goals
Account Receivables Specialist
United Vein & Vascular Centers
Tampa, FL
09.2021 - 05.2022
- Managed high-volume accounts receivable for hospital and medical provider claims
- Performed insurance follow-up on unpaid, underpaid, and denied claims to secure reimbursement
- Contacted commercial, Medicare, and Medicaid payers for claim status and resolution
- Reviewed EOBs and remittance advice to identify payment discrepancies
- Resolved coding, authorization, eligibility, and timely filing issues
- Submitted and tracked appeals and reconsiderations through payer portals
- Posted and adjusted insurance payments accurately in billing systems
- Verified coverage, benefits, and payer responsibility
- Maintained detailed documentation of account activity in Epic, Cerner, and payer portals
- Met productivity and accuracy standards while managing 60+ accounts daily
Revenue Cycle Specialist
Women's Care Florida
05.2018 - 09.2020
- Posted payments to accounts and maintained records.
- Calculated adjustments, premiums, and refunds.
- Corrected, completed and processed claims for multiple payer.
- Processed billing calls and answered questions from patients and third-party carriers.
- Processed online and paper appeal submissions and refund requests.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed over 70-80 follow-up calls regarding claim status with multiple payers.
- Identifying issue and reporting trends.
- Posted and adjusted payments from insurance companies.
- Promptly mailed or uploaded medical records needed to Insurance company for review.
- Handled account payments and provided information regarding outstanding balances.
- Reached out to insurance companies to verify coverage.
- Managed over 65 accounts daily.
Patient Account
Saint Barnabas Hospital
06.2005 - 07.2015
- Transferred balances to correct payers.
- Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures.
- Gathered information from multiple sources to simplify billing and organize accounts.
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
- Researched and followed up on denied insurance claims.
- Reviewed services rendered and completed to reconcile codes.
- Ability to balanced deposits and credit card payments each day.
- Assisted with minimizing risk exposure by reviewing claim validity and viability against coverage standards.
- Prepared reports detailing billing actions, flags and other key information.
- Posted payments and processed refunds.
- Managed over 50 patients calls per day for past due collection.
- Electronically submitted bills according to compliance guidelines.
Education
Certificate - Medical Billing
Bronx Community College of The City University of New York
NY08-2007
Skills
- Electronic Health Record (EHR) Systems: Epic, Cerner, Artiva, eClinicalWorks, McKesson
- Medical Coding: ICD-10, CPT, HCPCS
- Billing & Claims Management
- Revenue Cycle Management (RCM)
- Patient Account Management
- Denial Resolution & Accounts Receivable (AR)
- HIPAA Compliance & Healthcare Regulations
- MS Office / Excel / Billing Software
- Documentation and audit readiness
Certification
Medical Billing & Coding Certificate
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Revenue Recovery Specialist
Knowtion Health
05.2022 - Current
Account Receivables Specialist
United Vein & Vascular Centers
09.2021 - 05.2022
Revenue Cycle Specialist
Women's Care Florida
05.2018 - 09.2020
Patient Account
Saint Barnabas Hospital
06.2005 - 07.2015
Certificate - Medical Billing
Bronx Community College of The City University of New York