Work Preference
Summary
Overview
Work History
Education
Skills
Timeline
Generic
Open To Work

Terilynn Salas

New Port Richey,FL

Work Preference

Job Search Status

Open to work
Desired start date: Open to discussion

Desired Job Title

First Party Medical AdjusterPIP/Medpay Medical Claims AdjusterCustomer Solutions RepresentativeClaims Customer Service ExaminerPatient Accounts Representative

Work Type

Full Time

Location Preference

RemoteHybridOn-Site
Location: New Port Richey, FL
Open to relocation: No

Salary Range

45000/yr - 200000/yr

Important To Me

Work-life balanceCompany CultureHealthcare benefitsPaid time offPaid sick leave401k match

Summary

Dynamic, caring and accomplished professional with several years of expertise in PIP claims, insurance and medical billing, complemented by a strong background in Billing Office Management, Claims Customer Service and Claims Processing. Proficient in navigating the complexities of the medical insurance industry on the provider and insurance side, driving efficiency and enhancing operational workflows to optimize performance and revenue. Committed to delivering exceptional results through strategic problem-solving, compassionate care to clients and meticulous attention to detail, ensuring a high standard of service and satisfaction.

Overview

19
19
years of professional experience

Work History

First Party Medical Adjuster

Travelers Insurance
08.2022 - Current
  • Conducted comprehensive interviews of claimants to gather facts of loss ensuring accurate policy coverage and claim processing.
  • Analyzed information gathered by investigations to report findings and make recommendations to clients and internal teams Including nurse referrals and specials investigations.
  • Responded to client, attorney and provider inquiries regarding claim status and policy details in a very fast paced and changing environment.
  • Daily processing of medical bills utilizing applicable fee schedules and policy provisions according to Florida statutes.

PIP/Medpay Medical Claims Adjuster

Progressive Insurance Companies
03.2021 - 08.2022
  • Highly proficient PIP and Medpay claims adjuster with excellent investigation and record keeping skills.
  • Verified insurance and policy coverage for injured parties utilizing facts of loss and other resources as necessary.
  • Cultivated and nurtured trustworthy relationships with clients, attorneys, and internal colleagues to support policyholders and business needs.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, procedures and HIPAA regulations.

Customer Solutions Representative

St. Luke's Cataract & Laser Institute
02.2020 - 03.2021
  • Delivered high-quality customer service to patients with medical billing inquiries.
  • Educated patients on claim and billing status, adjustments, and insurance coverage options.
  • Reviewed accounts for discrepancies and submitted for follow up ensuring timely resolution.
  • Performed insurance verification and soft collections, supporting accurate account management.

Claims Customer Service Examiner

HealthPartners
03.2017 - 08.2019
  • Advanced and dedicated customer service in response to provider inquiries using appropriate claims examination skills and determining critical content.
  • Researching benefits and analyzing contracts to determine claim processing accuracy. Assisting providers and educating next steps as necessary.
  • Consistently exceeded quality and productivity goals for over 2 years in a very fast-paced and demanding call center environment while providing engaging and exceptional customer service.

Patient Accounts Representative

HealthPartners
01.2013 - 03.2017
  • Provided customer service in response to patient billing inquiries in a call center environment.
  • Diffusing and resolving complaints, negotiating payment plans and accepting payments.
  • Working with patients on account balances and explaining outcomes while focusing on account resolutions.
  • Processing healthcare insurance claims and utilizing several different resources for claim adjudication such as spreadsheets, internal and external websites and insurance verification for multiple insurance payers.

Billing Office Manager

Take Care Chiropractic
10.2007 - 01.2014
  • Managed medical billing operations for a busy chiropractic and wellness office, overseeing the full billing cycle.
  • Performed daily accounting of accounts receivable including payments and subrogation activities.
  • Created and implemented electronic billing procedures and conducted account audits for accuracy.
  • Assisted doctors and staff with marketing and networking strategies to support office growth.

Education

6 20 All Lines Florida Certified Claims Adjuster -

AdjusterPro
New Port Richey, Florida
06.2020

ICD9/10 Coding Course - undefined

AAPC
St. Paul, Minnesota
08.2015

Secondary Education - undefined

University of Minnesota - Twin Cities Campus
Minneapolis, MN
06.2009

High School Diploma - undefined

St. Paul Central High School
St. Paul, Minnesota
06.1991

Skills

  • Coverage Investigations
  • Auto injury claims
  • Customer service
  • Efficient multi-tasker
  • Data analysis skills
  • Excellent written and communication skills
  • Critical thinking
  • Claims processing
  • Decision making
  • Business office management
  • Interpersonal skills
  • Detail oriented
  • Self motivated and driven

Timeline

First Party Medical Adjuster

Travelers Insurance
08.2022 - Current

PIP/Medpay Medical Claims Adjuster

Progressive Insurance Companies
03.2021 - 08.2022

Customer Solutions Representative

St. Luke's Cataract & Laser Institute
02.2020 - 03.2021

Claims Customer Service Examiner

HealthPartners
03.2017 - 08.2019

Patient Accounts Representative

HealthPartners
01.2013 - 03.2017

Billing Office Manager

Take Care Chiropractic
10.2007 - 01.2014

ICD9/10 Coding Course - undefined

AAPC

Secondary Education - undefined

University of Minnesota - Twin Cities Campus

High School Diploma - undefined

St. Paul Central High School

6 20 All Lines Florida Certified Claims Adjuster -

AdjusterPro

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Terilynn Salas