Susanna Rivera

• Enhanced claims processing efficiency by streamlining workflows and implementing time-saving procedures.
• Utilized advanced analytical skills to identify inconsistencies or discrepancies in claims documentation.
• Processed adjustments and posted refunds.
• Collected information about rejected claims and developed effective solutions.
• Reviewed, evaluated, and processed incoming claims to determine eligibility for coverage based on policy provisions.
• Performed follow-up on unpaid or denied claims, as necessary.
• Collaborated with other departments within the hospital to resolve billing disputes or discrepancies between data sources.

PFS Rep II| Self Pay/Follow-Up | Baptist Health Systems

• Handling all Attorney Requests received by Baptist Medical Center
• Handling itemized bill requests received by Risk Management; Assisting attorneys on inbound calls
• Processing Settlement Requests received by Attorneys; Handling Cease-and-Desist accounts
• Correcting billing errors in Epic and Legacy systems for both HB and PB
• Exceeding production goals as provided by management.; Meeting goals on reports received by management;
• Assisted in training several employees.

• Meeting expectations of calls per hour inbound;Meeting QA expectations of 100% customer service quality
• Understanding and obtaining the ability to assist patients with billing questions and concerns accurately and proficiently
• Processing payments and applying adjustments according to established guidelines
• Perform corrections for patient registration information that includes but not limited to patient demographics and insurance information
• 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.