Yeisla Mary Marrero Rivera
Panama City,USA
Summary
Detail-oriented and bilingual Claims and Healthcare Operations professional with over 7 years of experience in claims adjudication, medical billing, reconciliation, ICD-9/ICD-10 compliance, and quality review. Expertise in processing complex and specialty claims, identifying coding errors, evaluating payment decisions, and ensuring adherence to organizational policies and CMS guidelines. Strong analytical and multitasking abilities have consistently led to improved claims accuracy and enhanced recovery outcomes. Ready to leverage skills and experience in a dynamic healthcare organization as a Claims Processing Representative, Claims Specialist II, or Specialist in Claims Recovery.
Overview
12
12
years of professional experience
Work History
Claims- Reconciliation Auditor
MMM Holdings
12.2018 - 12.2021
- Audited claims for accuracy and compliance with established guidelines.
- Provides feedback on claims processing errors; identifies quality improvement opportunities and initiates basic and complex system requests related to coding or system issues.
- Collaborated with providers to resolve claim-related inquiries and disputes.
- Identified discrepancies in claim submissions and initiated corrective actions.
- Evaluate coding according to established guidelines ICD-9 and ICD-10.
- Adjudicate claims in accordance with police terms and conditions.
- Refers overpayment opportunities to Recovery Team
- Prepared detailed reports summarizing audit results and recommendations.
- Adapted plans and schedules to meet changing priorities of work objectives, resources and workload demands.
- Handling of confidential information
Claims Analyst
Mennonite Hospital
12.2014 - 12.2018
- Reviewed and processed claims for accuracy and compliance with established guidelines.
- Collaborated with healthcare providers to resolve billing discrepancies and clarify claim requirements.
- Coding according to established guidelines ICD-9 and ICD-10
- Conducted thorough audits of claims submissions to identify errors and areas for improvement.
- Prepared detailed reports on claims metrics and presented findings to management for strategic decision-making.
- Trained new staff on claims processing procedures and best practices to ensure consistency and accuracy.
- Maintained strict confidentiality with all personal data as per company guidelines.
TSO Officer
ECP Airport
06.2025 - Current
- Conducted thorough security screenings for passengers and luggage, ensuring compliance with airport regulations.
- Engaged in continuous training and development to enhance threat detection and critical thinking skills.
- Operated advanced security screening equipment, effectively identifying potential threats.
Assistant Preschool Teacher - After care
FUMC Preschool
06.2023 - Current
- Observe each child to help them improve their social competencies and build self-esteem
- Assist in the supervision of all students in the classroom
- Encourage children to interact with each other and resolve occasional disagreements
- Develop a careful and creative program suitable for preschool children
- Employ a variety of educational techniques (storytelling, educational play, media etc.) to teach children
Pre-Conditional ESE Teacher
MKL School
08.2022 - 05.2025
- Plans and prepares engaging lesson plans, resources, learning activities, and assessments in advance as required by the principal, district, and Florida DOE requirements.
- Establishes and communicates clear learning objectives and outcomes.
- Monitors students’ understanding.
- Organizes and manages groups of individual pupils ensuring differentiation of learning needs.
Retail Associate
ROSS (Dress for less)
03.2022 - 08.2023
- Welcoming and engaging with customers as they enter the store.
- Assessing customers’ needs and suggesting solutions to their problems.
- Working with cash registers and processing payments.
- Cleaning and restocking the store throughout the day, before opening and after closing.
Administrative Assistant
Centro Pulmonar de la Montana
01.2014 - 07.2014
- Processing accounts payable
- Handling of confidential information
- Assist visitors and patients.
- Manage permission.
- Visit and incident log
Education
No Degree - Medical Billing
EDUTEC
Coamo, PR01.2014
BBA - Office Administration
University of Puerto Rico
Cayey, PR06-2013
Skills
- Proficient in autonomous execution
- Experienced in office administration tasks
- Experienced in medical coding standards ICD-9 and ICD-10
- Efficient task execution
- Audit reporting
- Report creation
- Proficient in bilingual communication
Timeline
TSO Officer
ECP Airport
06.2025 - Current
Assistant Preschool Teacher - After care
FUMC Preschool
06.2023 - Current
Pre-Conditional ESE Teacher
MKL School
08.2022 - 05.2025
Retail Associate
ROSS (Dress for less)
03.2022 - 08.2023
Claims- Reconciliation Auditor
MMM Holdings
12.2018 - 12.2021
Claims Analyst
Mennonite Hospital
12.2014 - 12.2018
Administrative Assistant
Centro Pulmonar de la Montana
01.2014 - 07.2014
No Degree - Medical Billing
EDUTEC
BBA - Office Administration
University of Puerto Rico