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.•Advanced understanding of commercial and Medicaid payers.•Knowledge of Medicare guidelines and able to accurately perform corrections according to CMS guidelines.•Exceled productivity standards as outlined by business line Exceeds a minimum of 92% work quality scoring and accuracy on all accounts worked.

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.• Pain Management Billing and Collections.• Processing of over 30 cases daily while maintaining and exceeding production quota monthly over 100%.

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 using established criteria of Medicare and independent insurance guidelines and policies.• 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 details and use.Authorizations Request/Approvals from providers and process according to time frames expedited or standard.

• 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 using established criteria of Medicare and independent insurance guidelines and policies.• 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. • Verify member eligibility and benefits, determine provider contracting status, review of documentation EOB Benefits, medical records, and insurance plan documentation.• Posted electronic payment remittance (EPR), electronic funds transfer (EFT), resolve difficult issues working independently to case, by generating system/written decision letters according to case resolution.• Processing of over 40 cases daily while maintaining and exceeding production quota monthly over 100%.

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 testing. Wrote letters of medical necessity, followed up on cases in medical review and handled denials/appeals from independent insurance co and Medicare. • 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. • Assists patients in the scheduling of appointments with the specialist or facility to which the patient has been referred and scheduling transportation, if necessary. Prepared code review for DME bill collection.• Created audit reports for cost control and better business processes.• Achieved revenue goals • Filed and tracked insurance claims and communicated claims status to patients.

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 portals for specialty care or treatments, and additional clinical testing.Processed Grievance and Appeals, wrote letters of medical necessity, followed up on cases in medical review and handled denials/appeals from independent insurance co and Medicare. Managed multiple accounts in monthly collections for Ophthalmologist and Gastrointestinal Centers.Slashed payroll/benefits administration in collection amount for each account of $100,000.00 monthly, while ensuring the continuation and enhancement of services. Monitor fee schedules and insurance payments to ensure fully allowed reimbursement.Conduct weekly meetings with the RCM team to provide guidance and feedback regarding claims processing.Submits completed prior authorization forms to the appropriate Utilization Management department 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).