SHARITZA RUIZ
Colorado Springs
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
8
8
years of professional experience
Work History
Claims Processing Clerk
Carenet
08.2021 - 01.2024
- Process and submit claims for 60 patients daily, ensuring accuracy and timely submission to maximize revenue cycle efficiency.
- Investigated claims, conducted field audits, determined losses, and reported findings.
- Managed accounts receivable and follow-up on outstanding claims, reducing aging receivables by 37%
- Generate and maintained reports on billing and claims data for management review.
- Negotiated and settled claims according to information presented through reports, research, and data verification.
- Managed data entry tasks such as updating member information and maintaining filing system.
Medical Claims Processor
TELADOC
07.2018 - 01.2021
- Coordinated patient benefits and insurance eligibility for over 70 patient daily, ensuring timely and accurate verification and authorization of services.
- Educated patients on their insurance benefits, coverage options, and financial responsibilities, enhancing patient understanding and satisfaction
- Maintained accurate and up-to-date records in the electronic medical record system ensuring compliance with HIPAA regulations.
- Assisted in the appeals process for denied claims, researching and providing necessary documentation to support resolutions.
- Managed patient inquiries via telephone and email regarding insurance benefits and billing, providing clear and concise information to enhance understanding
Medical Coding and Billing Specialist
Eversource
09.2015 - 08.2018
- Maintained patient confidentiality by adhering to strict HIPAA regulations during all aspects of the coding and billing processes.
- Enhanced accuracy of medical coding by implementing a thorough review process and cross-checking system.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
Skills
- Customer Service
- Data Entry
- Healthcare Industry Knowledge
- HIPAA Compliance
- Claims Processing
- Insurance Verification
- Typing Proficiency 55 wpm
- Inbound and Outbound Calling
- Microsoft Office
- Claim Denial Resolution
- Time Management
- Appointment Scheduling
Timeline
Claims Processing Clerk
Carenet
08.2021 - 01.2024
Medical Claims Processor
TELADOC
07.2018 - 01.2021
Medical Coding and Billing Specialist
Eversource
09.2015 - 08.2018
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