Eunice Cueto Email & Phone Number

Hollywood, FL, US

Hollywood, Florida, US

Memorial Hospital

Hendersonville, Tennessee, US

• Responsible for Billing recovery for Vanderbilt University Hospital according to company, client, and federal guidelines.
• Resolve and coordination of Workers Compensation Claims Case Management with physicians and other health care professionals. Investigated and processed claims reports and medical records supporting documentation.
• Understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, EOB coding review, rejections, and other claim functions).
• Compiles appeals and approves appeal requests for team related to technical payment denials.
• Work within federal, state regulations, department/division & all Compliance Policies.
• Maintain clear, concise, and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications.

Nashville, Tennessee, US

• Review, research, and resolve complex claims processing issues, including Service Requests, Provider Disputes, Member billing issues in a timely filing manner.
• Coordinated Workers Compensation Claims with physicians and other health care professionals. Investigated and processed claims reports and medical records supporting documentation.
• Pain Management Auto/Liability Cases processing
• Make outbound calls/emails to resolve outstanding balances.
• Prepare and maintain records of accounts receivables, including receipts.
• Appeals process first level and 2nd level to Medicare and Commercial Insurance Carriers.

Bloomfield, CT, US

• Review, research, and resolve complex claims processing issues, including Service Requests, Provider Disputes, member billing issues, adjustment projects and non-complex grievance and appeals, according to the legal.
• Achieved and consistently exceeded revenue quota.Resolved grievances and created effective solutions. Answered in-person email and telephone inquiries from customers. Set up account files and educated members on.

• Senior Billing and Recovery Case Specialist for CMS(Medicare)/Legal Audit Government.
• Processed Appeals with a high level of efficiency, coordinating required documentation and preparing well as issuing written decisions letters to the appropriate parties.
• Review, research, and resolve complex claims processing issues, including Service Requests, Provider Disputes, member billing issues, adjustment projects and non-complex grievance and appeals, according to the legal.
• Audit a designated percentage of all daily processing production for assigned staff members (including errors from claims pricing, adjudication, adjustments, member bill issues, and mail).
• Practitioner/provider group credentialing audits for initial, annual, and interim assessments in accordance commercial insurance and CMS regulatory requirements.
• Submit a monthly summary report of findings to the Claims Support Services Supervisor of all errors.

Chicago, IL, US

• Licensed Health Agent Client/Account Relationship. Customer Service
• Enrollment for MAPD/PD plans. Achieved and consistently exceeded revenue quota
• Resolved grievances and created effective solutions. Responded to customers request for products, services, and company information
• Cultivated customer loyalty, promoted repeat customers, and improved sales.
• Answered in-person email and telephone inquiries from customers. Set up account files and educated members on details and use.

• Independently managed Billing (DME & Per Diem) paper CMS1500 and electronic primary, secondary and tertiary claims submissions.
• Obtained pre-certifications, authorizations and referral process from health plans, hospitals, providers, customers and vendors via fax, phone, and portals for specialty care or treatments, and additional clinical.
• Submits completed prior authorization forms to the appropriate Utilization Management department
• Negotiate and enforce collections to recover funds on delinquent accounts.
• Settle years of open balances in patients accounts with successful collections of open balances.
• Payment posting ensuring patients accounts are complete and ready for billing charge entry.

Financial Client/Account Relationship Manager for Ophthalmologic and Gastrointestinal Surgical Centers. Production Quota Products, Checks, Demands, Defenses, Payments. Denial’s investigation, Authorizations.Obtained pre-certifications, authorizations and referral process from health plans, hospitals, providers, customers and vendors via fax, phone, and.