Moniko Robin

Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.

Medical Reimbursement Specialist/Medical Claims Processor at UnitedHealth Group (2021-05 – Present)

• Handle a high volume of inbound and outbound calls related to medical claim reimbursements, denials, and patient account inquiries.
• Review, research, and resolve reimbursement issues including claim underpayments, overpayments, and denials for commercial, Medicare, and Medicaid claims.
• Work directly with insurance payers to follow up on delayed or denied claims and secure appropriate reimbursement. Submit corrected claims, appeals, and reconsideration requests following payer-specific guidelines.
• Verify insurance benefits, eligibility, and authorizations to support claims resolution. Process patient refunds, account adjustments, and reconcile patient balances or credits when appropriate.

Patient Access Representative at NTT Data (2018-10 – 2021-05)

• Answer inbound calls and make outbound calls related to patient scheduling, registration, and service inquiries.
• Verify patient insurance eligibility, benefits coverage, and co-pay/deductible requirements. Contact insurance companies and use payer portals for up-to-date benefits information.
• Obtain and track prior authorizations and referrals for procedures, diagnostics, and specialist visits. Follow up with providers and payers to avoid delays in patient care.
• Assist uninsured patients in exploring Medicaid, charity programs, or financial aid options. Provide front-end support for patient billing inquiries.

Medicare Customer Service Representative at Morrison/Ochsner (2013-09 – 2017-10)

• Answer high volume of inbound calls from Medicare members regarding plan benefits, provider networks, coverage, copays, billing, ID cards, and preventive services.
• Provide personalized customer service to members aged 65 and older, ensuring clear communication, patience, and support for individuals with varying levels of health literacy.
• Assist callers with understanding their Medicare Advantage, Dual-Eligible (Medicare/Medicaid), or Part D Prescription Drug Plan benefits.
• Schedule preventive care visits, wellness exams, or care coordination follow-ups to improve member engagement and plan compliance.

Prior Authorization Representative/Insurance Verification Specialist at Comprehensive Nursing Services (2008-01 – 2013-09)

• Handled high-volume inbound and outbound calls to verify insurance coverage and obtain prior authorizations for medical services, diagnostic tests, and prescriptions.
• Collaborated with physicians, clinical staff, and schedulers to gather necessary documentation, including medical necessity and referral information.
• Entered and updated insurance information, authorization numbers, and patient demographics accurately in EMR/EHR and billing systems.
• Interpreted EOBs, payer guidelines, and policy requirements to resolve coverage issues, denials, or authorization rejections.

High School Diploma – Christ First Christian Academy