Susanna Rivera
Orange Park,FL
Summary
Dependable Customer Service Self-Pay Specialist with a track record of success in the field, attention to detail, and a proactive mindset. Seeks opportunities to improve processes and workflows for team benefit. Conscientious, hardworking, and excels at multitasking in fast-paced environments.
Overview
16
16
years of professional experience
Work History
Claims Resolution Specialist
Baptist Health
Jacksonville, FL
03.2024 - Current
- Reviewed, evaluated and processed incoming claims to determine eligibility for coverage based on policy provisions.
- Analyzed claim documents, such as medical records, bills and invoices, to ensure accuracy of information.
- Updated internal database system with pertinent information regarding each claim file.
- Researched patient's account status to ensure timely processing of claims.
- Verified accuracy of billing information and corrected errors before submitting claims.
- Performed follow-up on unpaid or denied claims, as necessary.
- Identified trends related to denials, rejections, delays in payment.
- Collaborated with other departments within the hospital to resolve billing disputes or discrepancies between data sources.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
Customer Service Self Pay Specialist
Baptist Health
Jacksonville, FL
10.2019 - 03.2024
- Defined team directions and provided guidance to members.
- Created training materials for new hires on the company's procedures and policies.
- Processed Attorney Requests for billing records received by Baptist Medical Center for Hospital and Physician accounts in EPIC and legacy systems.
- Processed itemized bill requests received by Risk Management.
- Assist attorneys on inbound calls
- Processed Settlement Requests received by Attorneys
- Handled Cease-and-Desist accounts
- Identified customer needs, clarified information, researched every issue and provided solutions.
- Followed up with customers to ensure resolution of their issues or concerns.
- Developed strong relationships with customers by responding promptly to inquiries.
- Suggested process improvements based on observed trends from customer interactions.
- Performed data entry into computer system to document all call activity accurately.
- Exceeded daily number of outbound calls as provided by management.
Patient Financial Services Representative
Baptist Health
Jacksonville, Florida
05.2018 - 09.2019
- Answered incoming calls from patients regarding billing inquiries and resolved customer service issues.
- Processed payments accurately and efficiently in a timely manner.
- Assisted in the maintenance of patient accounts to ensure accuracy of information including demographic, insurance and financial data.
- Researched and responded to customer inquiries via phone, email, or mail regarding billing statements, services rendered.
- Managed collection efforts by working directly with patients on payment plans or arrangements that meet their needs while keeping within company guidelines.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
- Ability to read explanation of benefits (EOB); Review Medical Record documentation to identify services provided by physicians as it pertains to claims that are being filed.
Car Detailer
Charles & Georges Car Wash
Orange Park, FL
12.2007 - 05.2018
- Maintained detailed records of all services performed on each vehicle.
- Cashier, maintained time keeping for employees, accurately balanced books at end of day, including tips, handled incoming calls from customers
- Checked for any damage to the vehicle's interior or exterior before beginning detailing work.
- Cleaned cars both externally and internally by hand or with use of automated equipment.
- Applied dressing to vinyl surfaces such as dashboards, door panels, consoles and armrests.
- Mixed cleaning solutions, abrasive compositions, or other compounds according to formulas.
- Monitored operation of cleaning machines and stopped machines or notified supervisors when malfunctions occurred.
- Removed tar spots, tree sap and bird droppings from exterior surfaces using special cleaning solutions.
- Inspected vehicle to verify pristine appearance for customer.
Education
Associate of Science - Information Technology
Florida State College At Jacksonville
Jacksonville, FL12-2024
High School Diploma -
Orange Park High School
Orange Park, FL03-2017
Skills
- Quality Assurance
- Complaint resolution
- Inbound and Outbound Calling
- Professional telephone demeanor
- Microsoft Office
- Abide by HIPPA regulations
- Ability to work in a fast-paced environment with a wide range of responsibilities
- Complete understanding of the medical billing revenue cycle
Timeline
Claims Resolution Specialist
Baptist Health
03.2024 - Current
Customer Service Self Pay Specialist
Baptist Health
10.2019 - 03.2024
Patient Financial Services Representative
Baptist Health
05.2018 - 09.2019
Car Detailer
Charles & Georges Car Wash
12.2007 - 05.2018
Associate of Science - Information Technology
Florida State College At Jacksonville
High School Diploma -
Orange Park High School