VERONICA OSABA
Menifee,CA
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills.
Overview
19
19
years of professional experience
Work History
Denials & A/R Analyst II
Providence/ R1
Chicago, IL (Remote)
12.2023 - Current
- Analyze reimbursement of claims to ensure proper payments.
- Submit appeals to providers for reprocessing of claims for additional payment.
- Conduct audits of patient claims to identify errors or inconsistencies that could impact timely reimbursements.
- Manage high volume caseloads effectively while maintaining strict deadlines for submission of appeal submissions.
- Follow up on denied and unpaid claims to resolve problems and obtain payments.
- Coordinate with insurance companies to verify customer's policy benefits in relation to claims.
- Deliver timely information to insurance representatives to resolve common and complex issues.
- Submit insurance coverage updates to correct variances
- Support team members by sharing expertise in reimbursement methodologies and payer contracts analysis.
- Help upload documents onto Onbase for secure access across the organization.
Patient Finance Service - Reimbursement Representative
KPC Health
03.2021 - 12.2023
- Prepare denial reports weekly and adjust accounts accordingly or refer for appeals.
- Update all insurance information for patients to ensure accuracy.
- Utilize websites to verify and assist collectors.
- Makes all the contractual adjustments to properly reflect the correct expected reimbursement for three hospitals.
- Review payments from commercial, Medi-cal, and Medicare senior plans to make sure they are correctly paid to our contracts.
- Meet with management weekly to effectively communicate issues, set and prioritize goals to improve processes.
- Bill and rebill claims through Nthrive.
- Help resolve issues identified by reimbursement team with management and director.
- Report all Contract Management errors to upper management.
- Submit all insurance and patient refunds to A/P department.
- Perform scanning, indexing and insurance verifications.
Variance/ Reimbursement Analyst
UHS, Inc.
07.2011 - 05.2020
- Assigned insurance contracts to analyze for variance discrepancies.
- Prepared master reports through the data warehouse or Excel to pull up accounts to identify underpayments, overpayments and misapplied payments.
- Identify that correct insurance contracts were loaded to accounts to ensure accuracy of payments.
- Worked with assigned provider relations to expedite payments for high volume accounts.
- Submitted underpayment provider appeals with appropriate documentation as required by managed care guidelines.
- Provide input regarding workflow improvements, participating in inter-department committee meetings and make recommendations.
- Ensure that all new system updates maintain the accuracy of payments and that all financial controls remained in place according to contract set in place for that quarter/year.
- Communicated with management and Contract Management for quarterly updates.
Credit Analyst
UHS, Inc.
10.2010 - 07.2011
- Prepared reports through the data warehouse or Excel to pull up all credit balances to review.
- Took appropriate measures to correct credits which included: Updating insurances, refunding insurances and patients.
- Reviewed patient credits for refund or transfers.
- Responsible to call insurance companies and patient to assist correct account information.
Health Plan Representative
CVS Caremark
02.2006 - 03.2009
- Audited claims to ensure proper payment according to contract.
- Prepared spreadsheets in Excel to show progress of collections on a monthly basis and communicated results to management.
- Communicated with accounts managers to address contractual issues to be logged for correction and ensure proper payments.
- Determined collection actions to be taken on delinquent accounts within collection guidelines.
- Liaised between customers and health plan providers.
- Primary and secondary billing utilizing pharmaceutical platform.
- Assigned to appeal issues directly with our provider-relations staff versus dealing with customer service representatives.
Education
Associate of Arts -
Riverside Community College
Bachelor of Arts - Business, Finance
California State University San Bernardino
Certificate - Spanish interpretation
University of California, Riverside
Skills
- Superior customer service skills
- 20 years’ experience with Medicare, Medicaid/Medi-cal, Commercial and HMO payers claims processing
- 10 key by touch
- Data Entry
- Office software (Excel, Word, Powerpoint), Siemens SMS, Envision, Nthrive, Emdeon, Navinet, Availity, Sharepoint, AVES, Cerner, Data Warehouse, Paragon, E-Premis, Epic, Onbase)
- ICD-10 CM, HCPCS and CPT
- Type 60 words per minute
- Accounts Receivable
- Account Payable
- Spanish
- Claims analysis
- Reimbursement processes
Timeline
Denials & A/R Analyst II
Providence/ R1
12.2023 - Current
Patient Finance Service - Reimbursement Representative
KPC Health
03.2021 - 12.2023
Variance/ Reimbursement Analyst
UHS, Inc.
07.2011 - 05.2020
Credit Analyst
UHS, Inc.
10.2010 - 07.2011
Health Plan Representative
CVS Caremark
02.2006 - 03.2009
Associate of Arts -
Riverside Community College
Bachelor of Arts - Business, Finance
California State University San Bernardino
Certificate - Spanish interpretation
University of California, Riverside
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