Ralvene Paulino
Elmwood Park
Summary
To secure a position with a well established organization with a stable environment where I can utilize my strong analytical , detail oriented and interpersonal skills, excellent time management and problem-solving skills.
Overview
14
14
years of professional experience
Work History
Insurance Verifier
Humboldt Park Health
05.2021 - Current
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Established contact with ordering physician's office to resolve any issues or to collect missing vital information.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Established and maintained relationships with insurance provides for productive communications.
- Checks daily admission reports and/or surgical procedures, outpatient schedules to ensure all patients are accounted for.
- Review and updates incorrect patient, guarantor on insurance information entered in the Meditech Expanse Admissions module as necessary.
Client Service Representative
Ciox Healthcare
02.2020 - 12.2020
- Validates requests and authorization for releases of medical information according to establish procedures and HIPPA guidelines.
- Complete releases of information request including retrieving patient's medical charts and scanning medical records accurately and correctly, according to request established procedures and established standards of quality and productivity and electronically transmits medical records to processing operations.
- Perform quality checks on all work to assure accuracy of release, confidentiality , and proper invoicing.
- Processing billings for patients direct records, insurance, attorney and subpoena.
Health Information Technician II
AMITA Health
12.2009 - 12.2018
- Verified accuracy of patient information in medical records.
- Transcribed and entered patient medical information into electronic medical records systems.
- Scanned and uploaded medical records into electronic medical records system.
- Protected patient privacy by adhering to HIPAA regulations and maintaining strict confidentiality protocols.
- Collaborated closely with physicians and nursing staff to improve quality of patient records documentation.
- Conduct physicians suspensions and physicians warning letters reports.
- Audit deficiencies in Epic system for residents, Units and nurses.
- Conduct Birth certificate interview.
- Medical records analysis for all inpatient , observation , emergency records.
Education
Awarded Home Health Aid.
Casa Central
Chicago, IL11.2023
Certification in CPR Certified.
American Red Cross
Chicago, IL10.2023
Certification in Food Service Program
Food Service Educational Seminar
Chicago, IL04.2018
Associate of Science - Computer And Information Systems.
St. Augustine College
Chicago, IL05.1997
High School Diploma -
St. Thomas De Aquino
Dominican Republic05.1991
Skills
- Meditech/EPIC
- Data review
- CPR Certified
- Coverage and Authorizations
- Prior authorization processing
- Medical Terminology
- Excellent Customer Service
- Bilingual English/Spanish
- Organizing and Planning skills
- Team Player
Timeline
Insurance Verifier
Humboldt Park Health
05.2021 - Current
Client Service Representative
Ciox Healthcare
02.2020 - 12.2020
Health Information Technician II
AMITA Health
12.2009 - 12.2018
Awarded Home Health Aid.
Casa Central
Certification in CPR Certified.
American Red Cross
Certification in Food Service Program
Food Service Educational Seminar
Associate of Science - Computer And Information Systems.
St. Augustine College
High School Diploma -
St. Thomas De Aquino
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