Terilynn Salas
New Port Richey
Summary
Dynamic and accomplished professional with over 15 years of expertise in PIP claims and medical billing, complemented by a strong background in Billing Office Management, Claims Customer Service, Claims Processing, and Follow-Up. Renowned for dependability and leadership, consistently surpassing departmental and organizational objectives while fostering a collaborative team environment. Proficient in navigating the complexities of the medical insurance and provider sectors, driving efficiency and enhancing operational workflows to optimize performance. Committed to delivering exceptional results through strategic problem-solving and meticulous attention to detail, ensuring a high standard of service and satisfaction.
Overview
18
18
years of professional experience
Work History
First Party Medical Adjsuter
Travelers Insurance
08.2022 - Current
- Analyzed information gathered by investigations to report findings and recommendations.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Examined claims forms and other records to determine insurance coverage.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
PIP/Medpay Medical Claims Adjuster
Progressive Insurance Companies
03.2021 - 08.2022
- Highly proficient PIP and Medpay claims adjuster with excellent investigation and negotiation skills.
- Coverage investigations, policy interpretation and application, claim payment and complex case resolution.
- Develop and maintain consistent and trustworthy relationships with clients, attorneys, IME vendors and internal collegues.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Processed insurance payments and maintained accurate documentation of payments.
- Verified patient insurance coverage and benefits for medical claims.
Customer Solutions Representative
St. Luke’s Cataract & Laser Institute
02.2020 - 03.2021
- Providing high-quality and world-class customer service to patients with medical billing inquiries.
- Educating patients on claim and billing status, adjustments, insurance and collection recovery.
- Reviewing accounts for discrepancies and submit for follow up.
- Processing credit card payments and maintaining a daily ledger.
- Soft collections and insurance verification.
- Provided feedback on product or service improvements to better meet customer needs and expectations.
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.
- Reviewing benefits and contracts to determine claim processing accuracy. Assisting providers and educating next steps as necessary.
- Maintained confidentiality and security of personal information to protect customer privacy and prevent identity theft.
- 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
- Procuring customer service and loyalty 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.
- Claim corrections, resubmission to insurance and follow up on denials and rejected claims.
Billing Office Manager
Take Care Chiropractic
10.2007 - 01.2014
- Expertly managed medical billing for a busy chiropractic and wellness office.
- Responsible for full billing cycle service including claim creation to collections and follow up on all accounts.
- Daily accounting of all AR including patient and insurance payments and subrogation.
- Created and implemented electronic billing procedures and performed account audits.
- Assist doctors and chiropractic assistants with marketing and networking strategies.
- Streamlined office procedures and policy implementation.
Education
6 20 All Lines Florida Certified Claims Adjuster -
AdjusterPro
New Port Richey, Florida06.2020
Real Estate Sales - undefined
Tampa School of Real Estate
Tampa, Florida08.2019
ICD9/10 Coding Course - undefined
AAPC
St. Paul, Minnesota08.2015
Secondary Education - undefined
University of Minnesota - Twin Cities Campus
Minneapolis, MN06.2009
High School Diploma - undefined
St. Paul Central High School
St. Paul, Minnesota06.1991
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 Adjsuter
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
Real Estate Sales - undefined
Tampa School of Real Estate
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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