Provider Services Associate - Alorica - Onsite
(2012-09 - 2015-05)
- Provide benefit, eligibility and authorization status to providers and insurance companies.
- Provide claim status, denials and appeals.
- Address provider inquiries, complaints and concerns by providing timely and accurate information or escalating to the manager.
- Document provider interactions, managing provider data in databases and handling correspondence.
- Ensuring providers are satisfied and informed.
Recovery Resolutions Analyst - United Health Group/OGS - Onsite
(2015-06 - 2019-01)
- Identifies and resolves rejected or denied claims by working with insurance payers and providers
- Skip tracing on hospital POCs phone #
- Investigate and identify overpayments on all claim types, assist in recovery and resolution.
- Communicate with provider point of contact and send refund request letter to providers.
- Collect overpaid claims and assist providers with the refund process.
Senior Billing Quality Analyst - Optum Global Solutions - WFH
(2019-01 - 2024-08)
- Conducting audits to identify errors and ensure compliance, generating monthly reports on associates performance.
- Collaborating with other department and onshore counterparts to align recurring issues and plan targeted coaching or refresher training sessions.
- Document audit results in a standardized tracker and ensure completeness and consistency of findings.
- Support calibration sessions to maintain scoring alignment with client and operational leads.
- Provide clear and structured feedback to specialists based on audit results.
- Handle QA-related inquiries, audit appeals, validate audit logic and update feedback if necessary.
- Identify patterns and recurring errors from audit results and escalate major discrepancies to Team Lead.
Independent Contractor - Central Billing Bureau - WFH
(2025-02 - 2025-06)
- Claim submission: preparing and submitting clean claims to insurance companies.
- Insurance verification: confirming patient insurance coverage and benefits
- Payment Posting: recording payments received from payers and reconciling accounts.
- Account Receivable Management: Tracking outstanding balances, following up on unpaid claims and managing denials and appeals.
- Demographics Entry: maintaining accurate and verifying patient personal information and insurance company in the practice management system to ensure clean claim submission, proper revenue cycle management and efficient patient care. Creating new patient accounts, capturing insurance and eligibility details while maintaining patient confidentiality to prevent claim denials, delayed payments and revenue loss.
- Compliance: adhering to HIPAA billing standards and payer guidelines
Independent Contractor - Omnia Company - WFH-Part Time
(2025-09 - 2026-07)
- Insurance Verification: confirming patient insurance coverage and benefits with insurance companies
- Check patient eligibility through Availity and verify patient demographics and policy number accuracy.
- Benefit Verification: review what services are covered and any limitations or exclusions. Confirm details such as: copays, coinsurance, deductibles and OOP maximum, INN and OON benefits, authorization or referral requirements and visit limits.
- Documentation: record verified details in the system (Manual Call Form) and note the rep name and reference #.
- Performed claims status verification to ensure timely claim processing and reimbursement.
- Conducted payer follow-up on outstanding claims to resolve denials and payment delays
- Managed claims follow-up by contacting insurance carriers to obtain claim status and expedite payments.
