Experience

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  Provider Network Solutions, LLC

  • Miami, Florida, United States

  • Customer Service Supervisor

    • Mar 2021 - Feb 2023
    • Miami, Florida, United States

    • Answer calls, from providers to verify eligibility and provide them with claims payment status. • Search for members navigating through the TPA System and main health plan sites in order to check on member eligibility. • Read and comprehend paid and denied claims and explain denial codes. • Educate providers on the appeal/claim submission process and provider portal use.• Demonstrate professional etiquette and courtesy when interacting with providers.• Accurately and comprehensively documents all communications from providers based on organization policies and procedures through investigative research to create internal PDR’s. internal open tickets.• Assist the Claim Department by entering appeals in the TPA System.• Assist the health plan by providing participating physicians information within the network per line of business (LOB). • Assist the other customer service representatives on escalated issues. • Support coverage for mailroom • Support coverage for EDI Specialist• Process daily pending eligibility review for claims department workflow .• Generate provider letter weekly for rejected claim.• Generate and mail daily NABD & NDP letters.• Create refund letters and upload supporting documents in the claims processing system• Review deductibles and out of pockets accumulators’ queue for claims department• Distribute faxes that are received daily to all departments. • Performs other duties as assigned by Management

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  Lotus Counseling Center

  • Miami, Florida, United States

  • Office Supervisor

    • Nov 2019 - Jan 2021
    • Miami, Florida, United States

    • Answer calls from potential and current clients, along with scheduling of new and current clients.• Match potential clients with psychologist that best meet their needs, schedule and insurance.• Verify clients insurance eligibility and benefits.• Collect member personal and insurance information, provide and process all necessary paperwork, create charts for new clients.• Supervise and coordinate the daily activities and operations of the office; 15 therapists and 3 administrative staff.• Approve and monitor staff vacations and sick leave and any scheduling conflicts.• Process and monitor accounts receivable and payable, along with collections of any current or past due payments.• Plan and organize the purchase of office supplies in accordance with purchasing policies and budgets.• Ensure adherence to quality, cleanliness and compliance standards.• Initiate and maintain orderly client records in compliance with company, HIPAA and insurance compliance regulations.• Review, modify and update contracts for therapists who were independent contractors.• Provide necessary training and onboarding of therapist, office administrators as well as , guidance and motivation to staff.• Monitor, create, update and schedule of all social media platforms: Google marketplace, Facebook Business and Instagram

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  J. Muir & Associates, P.A.

  • Miami, FL

  • Operations Manager

    • Feb 2014 - May 2019
    • Miami, FL

    • Responsible for the daily management of all client cases and files, including but not limited to digitizing all hard files into the Firm’s management system.• Responsible for invoicing and collecting monthly open balances.• Responsible for the creation and implementation of Firm Policy. Oversee employees’ daily work quality, consistency, and adherence to such policy.• Create and present weekly reports for Firm Partners informing them of the weekly progress of all pending cases.• Oversee financial matters including accounting, budgeting, and forecasting of all firm assets.• Execute all marketing and advertising campaigns for the Firm’s social media in adherence with Florida Bar Rules and Regulations.• Serve as a liaison between Partner’s, attorneys, and clients.

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  Fabric Innovations

  • Secondary Markets

  • Sales Associate

    • Mar 2011 - Dec 2013
    • Secondary Markets

    • Responsible for prospecting new business leads in local, regional, and national territories by performing comprehensive market research.• Successfully turned such leads into Clients for the Company.• Responsible for creating, implementing, and maintaining positive relationships between inside and outside sales.• Represented the Company at trade shows and conferences in order to maintain up to date knowledge of industry trends, generate potential sales leads, and network with industry contacts.• Established, implemented and responsible for the adherence of processes and procedures for product sampling, pricing list with lead times and quantity discounts.• Responsible for managing projects from inception - i.e., Sale of goods until successful product delivery. • Directly oversaw and successfully trained sales and administrative employees to fulfill their positions within the company.• Responsible for creating and implementing successful social media marketing campaigns.• Directly responsible for tracking sales leads of the company’s products and services, and for streamlining the company’s entire ordering process.

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  Exquisite Occasion

  • Miami, FL

  • Event Coordinator; Owner

    • Oct 2008 - Mar 2012
    • Miami, FL

    Planning and execution of special and corporate events.

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  South Florida ENT Associates, P.A.

  • Miami, FL

  • Office Coordinator

    • Nov 2009 - Apr 2011
    • Miami, FL

    Served as a direct liaison between patients, Health Insurance vendors, office management, and physicians, ensuring effective communication among all parties. Responsible for assisting the accounting department through the verification of patient insurance and the orderly documentation and filing of patient benefits. Successfully maneuvered the Health Insurance network through direct communications among all parties. Managed all issues of insurance, legal support, and matters of statutory compliance. Coordinated a wide array of office functions that focused on computerized scheduling, electronic billing, reimbursements, collections, accounts payable/receivable, patient records, data management, and payment plans, with a demonstrated knowledge of insurance carriers and medical terminology.

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  Miami Hand Center

  • Miami, FL

  • Office Manager

    • Jun 2007 - Nov 2009
    • Miami, FL

    Served as a direct liaison between patients, vendors, management, and physicians, ensuring effective communication among all parties. Responsible for assisting the accounting department through the verification of patient insurance and the orderly documentation and filing of patient benefits. Successfully maneuvered the Health Insurance network through direct communications among all parties. Managed all issues of insurance, legal support, and matters of statutory compliance. Coordinated a wide array of office functions that focused on computerized scheduling, electronic billing, reimbursements, collections, accounts payable/receivable, patient records, data management, and payment plans, with a demonstrated knowledge of insurance carriers and medical terminology. Responsible for implementing, overseeing, and streamlining form automation and a wide array of patient management tools for the Center directly attributable to improving Center efficiency.