Summary
Work History
Education
Skills
Languages
Timeline
Generic

Wilnelia Santana

Spring Hill

Summary

Results-driven professional with a strong background in claims processing and denial analysis. Skilled in coordinating follow-ups and engaging with patients, committed to delivering timely resolutions and improving overall operational efficiency.

Work History

Collection Specialist

Stymco Medical LLC
Tampa
2024 - 2026
  • Managed accounts with third-party biller CareCentrix, facilitating timely claims processing.
  • Handled denials and rejected claims from health insurance providers, including Cigna and United Healthcare.
  • Filed reconsiderations and appeals, tracking submission statuses to secure prompt resolutions.
  • Analyzed explanations of benefits (EOBs) to effectively address denials.
  • Contacted healthcare agencies through phone and online channels to resolve outstanding issues.
  • Engaged patients to gather information for claim processing and address cancellation inquiries.
  • Coordinated follow-ups with patients regarding necessary documentation for insurance claims.
  • Streamlined communication processes, improving responsiveness to patient inquiries.

Administrator Processor

Akorbi Staffing Company (ADT Health)
Palm Harbor
2023 - 2024
  • Created Excel spreadsheets for efficient billing processes.
  • Prepared bills for government and non-government agencies.
  • Analyzed EOBs for denials and rejections to identify trends.
  • Posted payments accurately to maintain financial records.

Patient Account Representative

Tritech Healthcare Management
Melville
2019 - 2023
  • Coordinated follow-ups with insurance companies and employers via email, fax, and websites to ensure timely resolution of outstanding claims.
  • Maintained accuracy of patient accident information through thorough review and updates.
  • Validated information provided by individuals or insurance companies to facilitate accurate medical bill payments.
  • Applied New York State rules regarding motor vehicle accidents in workplace settings effectively.

Claim Processor

Sunrise Medical Laboratories
Melville
2017 - 2019
  • Entered batches of client information into billing system efficiently.
  • Registered new patients and verified insurance eligibility promptly.
  • Applied daily charges to registered patients accurately.
  • Created electronic bills or paper claims based on registrants' insurance.

Medical Biller

Sunrise Medical Laboratories
Hicksville
2016 - 2017
  • temporary assignment handling batches of information from client portal to billing system

Medical Biller (160-Hour Externship)

Huntington Medical And Rehabilitation
Huntington Station
2015 - 2016
  • Executed insurance pre-authorizations and verification processes to ensure compliance with regulations.
  • Managed electronic and manual claim submissions, enhancing efficiency in billing operations.
  • Conducted claim appeals to resolve disputes and secure appropriate reimbursements.
  • Maintained HIPAA compliance in all medical billing and insurance processes.
  • Leveraged MS Office and Adobe tools for accurate documentation and reporting.
  • Oversaw medical insurance procedures to optimize revenue cycle management.

Special Projects Member

Tritech Healthcare Management
Melville
  • Educated new personnel on conducting self-pay calls to Spanish-speaking patients for accident-related information.

Education

Medical Billing And Coding

Branford Hall Career Institute
Amityville, NY
06-2016

Skills

  • Claims processing
  • Insurance verification
  • Electronic billing
  • Revenue cycle management
  • Denial analysis
  • Customer relationship management
  • Regulatory compliance
  • Patient engagement
  • Effective communication
  • Attention to detail

Languages

Spanish
Native/ Bilingual

Timeline

Collection Specialist

Stymco Medical LLC
2024 - 2026

Administrator Processor

Akorbi Staffing Company (ADT Health)
2023 - 2024

Patient Account Representative

Tritech Healthcare Management
2019 - 2023

Claim Processor

Sunrise Medical Laboratories
2017 - 2019

Medical Biller

Sunrise Medical Laboratories
2016 - 2017

Medical Biller (160-Hour Externship)

Huntington Medical And Rehabilitation
2015 - 2016

Special Projects Member

Tritech Healthcare Management

Medical Billing And Coding

Branford Hall Career Institute

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Wilnelia Santana