Wendy Sorto-Sosa
New York
Summary
Healthcare professional prepared for leadership roles in patient account management. Proven track record in enhancing billing processes and resolving patient account issues effectively. Known for fostering team collaboration and adapting to changing healthcare needs. Proficient in revenue cycle management and patient relations.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Senior Patient Account Representative
New York-Presbyterian Hospital
01.2023 - Current
- Promotes Psychiatry Patient Accounts department goals by selecting, motivating, and training capable team members.
- Acts a resource person for complex billing situations.
- Collects data, creates spreadsheets, and assists in analyzing findings. Conducts research and assists with special projects.
- Troubleshoots problems and communicates them, along with recommendations, to supervisor or manager for approval.
- Interfaces with physicians and administrators to ensure financial growth and stability; apprises physicians of new and revised procedures.
- Initiated thorough audits of past-due accounts to identify areas requiring immediate attention or potential writeoffs.
Senior Patient Account Representative
Northwell Health Labs
07.2018 - 12.2023
- Leading and developing a team of representatives responsible for the management, investigation, and resolution of claims.
- Request authorization for genetic testing for Medicare, Medicaid’s, Commercial insurance carriers.
- Experience leading teams in a collaborative, team-oriented environment; experience with employee development.
- Knowledge of billing and/or retrieval functions/ utilize v-lookup, filtering, and sorting functions.
- Prepare monthly/weekly agendas and reports for upper management.
- Create and improve workflow processes. Ensuring high quality of work and productivity of staff.
Third Party Billing Specialist
Professional Claims Bureau, Inc.
06.2017 - 07.2018
- Managed all inpatient and outpatient hospital claims including Commercial, Medicare, and Medicaid billing for the Long Island Jewish Medical Center division.
- Creates effective appeal packages to submit to insurances.
- Partnered with billing department colleagues to identify errors and develop solutions to daily challenges.
- Navigated first, second, and third level appeals for any ER denial, as per New York state requirements.
- Assists in monitoring accuracy of fee structure and reimbursement payment schedules from third party payers, all cash payment deposits and refunds.
Third Party Billing Specialist
Business Dynamics
02.2016 - 04.2017
- Delivered excellent customer service through phone and in-person patient requests, including necessary follow-up and scheduling.
- Knowledge in New York, No Fault & Workers Compensation Regulations.
- Performed charge entry for over 150 claims per day to appropriate billing payors.
- Review and run charge entry reports daily for accuracy.
- Contact and follow up with contracted insurance plans to reconcile delinquent client accounts.
- Mentored staff and advised of solutions to billing questions while guiding them through the appropriate tasks to perform within each billing cycle.
Education
Master of Accounting & Financial Management -
Keller Graduate School of Management
12.2023
Bachelor of Science - Healthcare Management, Healthcare Administration
DeVry University
New York, NY06.2022
Medical Billing & Coding Certificate - undefined
Sanford Brown Institute
New York, NY10.2011
Skills
- Critical thinking and analysis
- Data retention management
- Effective team management
- Data entry
- Utilization Management
- Claims denial resolution
- Skilled in creating Visio flowcharts
- Customer engagement expertise
- Tableau proficiency
- Strong verbal communication
- Data-driven decision making
- Cerner software expertise
- ADL
- Epic management
- Citrix
- Allscripts software expertise
- EPACES experience
- Eagle Systems expertise
Certification
Business Analytics
Timeline
Senior Patient Account Representative
New York-Presbyterian Hospital
01.2023 - Current
Senior Patient Account Representative
Northwell Health Labs
07.2018 - 12.2023
Third Party Billing Specialist
Professional Claims Bureau, Inc.
06.2017 - 07.2018
Third Party Billing Specialist
Business Dynamics
02.2016 - 04.2017
Bachelor of Science - Healthcare Management, Healthcare Administration
DeVry University
Medical Billing & Coding Certificate - undefined
Sanford Brown Institute
Master of Accounting & Financial Management -
Keller Graduate School of Management
Similar Profiles
STEPHANIE RODRIGUEZSTEPHANIE RODRIGUEZ
Client Services Coordinator - Patient Services at New York-Presbyterian HospitalClient Services Coordinator - Patient Services at New York-Presbyterian Hospital
JOSEPH GALIZIAJOSEPH GALIZIA
Critical Care Paramedic at New York-Presbyterian HospitalCritical Care Paramedic at New York-Presbyterian Hospital
Andrew MurrayAndrew Murray
Guest Services Representative at New York-Presbyterian HospitalGuest Services Representative at New York-Presbyterian Hospital
Alexandra HortonAlexandra Horton
Live-Out Nanny at The Saperstein FamilyLive-Out Nanny at The Saperstein Family
Jennifer MayaJennifer Maya
Portfolio Property Manager at Manhattan Skyline Management CorpPortfolio Property Manager at Manhattan Skyline Management Corp