NICOLE RIVERA
Rockford,IL
Summary
Very meticulous about the professionalism and the customer service experience that's given, when dealing with a customer. With over 25 years of customer service experience, with a core concentration in the healthcare revenue cycle field, from coast to coast. With this particular skill set allows and experiences, allows the freedom, to work within any subculture. With a "can-do attitude" along with a versatile and assertive approach in claims resolution. This has provided a strong ability to handle, even the most complex cases. These experiences and skill set, will be a great addition in improving revenue growth and helping create a smoother turnover rate with cash flow cycle, within the organization.
Overview
8
8
years of professional experience
1
1
Certification
Work History
PFS Representative
Mercy Healthcare
08.2023 - Current
- Responsible for ensuring claims are resolved with third party payers in a reasonable time frame as defined by Revenue Cycle metrics.
- Works with other areas in the Revenue Cycle to obtain information necessary to correct errors or supply additional information as necessary for claim adjudication.
- Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow-up.
- Identify trends with payor rejections or denials and escalates these trends to leads/supervisors.
- Meeting and exceeding daily metrics of over 65 accounts daily.
REVENUE SPECIALIST
EXCALIBUR
08.2021 - 05.2022
- Responsible for timely and accurate daily reports, monthly closing, quarterly, and annual reports
- Verifies and maintains record keeping of insurance information
- Timely and accurate submission of invoices to the appropriate payer
- Evaluates all payments and denials then properly post to residents' accounts
- Follows up on delinquent and inaccurate accounts
- Post payments and deposit checks daily
- Plus, any other function needed to ensure a steady flow of the revenue process; from resignation to final payment
REIMBURSEMENT SPECIALIST
OPTION CARE
04.2018 - 07.2021
- Responsible for the timely, accurate submission of invoices to responsible payers, of any type, for all services and products provided
- Evaluates payments received and apply application to the patient account
- Follows up with responsible parties to ensure the receipt of timely, accurate payments
- Assists with Billing and Collection Training and completes 'second level' appeals to payers
- Hitting and meeting company metrics
- Strong abilities in account resolution
REIMBURSEMENT SPECIALIST
LASALLE NETWORK TEMPORARY AGENCY
08.2017 - 04.2018
- Responsible for the timely, accurate submission of invoices to responsible payers, of any type, for all services and products provided
- Evaluates payments received and apply application to the patient account
- Follows up with responsible parties to ensure the receipt of timely, accurate payments
- Assists with Billing and Collection Training and completes 'second level' appeals to payers
CUSTOMER SERVICE AGENT
ALORICA
10.2016 - 08.2017
- Maintain accurate information in a face pace environment, that had a high call volume of customers.
- Ability to multi-task under high-pressure situations.
- Stayed current with information on the company's procedures for inbound and outbound callers.
- Training new employees on different application systems, work flows, job-aides, and other job specific materials.
- Demonstrated high attention to detail, organization and management of multiple task and projects simultaneously.
- Ability to manage and maintain extremely high volume of calls, while maintaining training assistant duties.
Education
GENERAL STUDIES -
IVY TECH COMMUNITY COLLEGE
Goshen, IN05.2013
Marketing -
Broome Community College
Binghamton, NY03.2001
Skills
- Proficient in Microsoft Office products
- Self-motivated
- Strong organizational skills
- Strong mathematics ability
- Highly adaptable
- Articulate
- Strong ability to prioritize
- Leadership ability
- Able to multitask
- Fast learner in new polices, work flow, and systems
- Quick learner
- Interpersonal skills
- Always closing
- Ability to recognize payer trends and denials
Certification
National Career Readiness Certificate, 9P5G7F708XMD
Timeline
PFS Representative
Mercy Healthcare
08.2023 - Current
REVENUE SPECIALIST
EXCALIBUR
08.2021 - 05.2022
REIMBURSEMENT SPECIALIST
OPTION CARE
04.2018 - 07.2021
REIMBURSEMENT SPECIALIST
LASALLE NETWORK TEMPORARY AGENCY
08.2017 - 04.2018
CUSTOMER SERVICE AGENT
ALORICA
10.2016 - 08.2017
GENERAL STUDIES -
IVY TECH COMMUNITY COLLEGE
Marketing -
Broome Community College
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