Michelle Castro Email and Phone Number

• Worked for the Insurance AR follow-up department• Reviewed & worked on HMO, PPO, dual insurance policies, & Medicare/Medicaid claims• Knowledge & understanding of Explanation of Benefits form (EOB), Medicaid & Medicare Managed Care Contracts, Contract Language, Federal & State Requirements, & hospital billing UB-04 form• Properly & safely handled confidential information by following HIPAA policies, rules, & regulations• Reviewed & validated accuracy of charges including dates of service, services provided, & location• Maintained an average of 85% closed or resolved accounts under six different hospitals per week• Resolved outstanding & high dollar accounts of over $5K by utilizing electronic health record systems such as Epic & Eagle to retrieve claim statuses, submit corrected claims, or to analyze coding discrepancies & medical necessity discrepancies• Data analysis experience which included finding trends in data within plans, products, & network rate differentials• Submitted appeals needed for denied procedures that are reimbursable according to contractual agreements based on the carriers timely filing• Provided coaching, support, & demonstration to colleagues & proactively provided input to improve processes & procedures• Daily use of carrier payer web portals, cross-referencing coding guidelines for CPT/HCPCS, ICD-10 coding errors & denial errors• Implemented Microsoft Excel's pivot table feature to efficiently complete tasks, enhancing productivity by 80% daily• Checked insurance eligibility & verification for different policies including workers compensation & no fault

• Experienced customer service representative in a fast paced business to business model startup tech company• Created a method to increase verifying patient insurance information & processing claims by 50%, which allowed my department to investigate patient billing & insurance rejections more effectively• Assigned pharmacy technician support when needed on certain days to help with the overflow of orders• Closely monitored inventory levels & outdated products; improved filing system to ensure inventory record accuracy by 78% by using Microsoft Excel• Designated to communicate with an outside/partner pharmacies on new orders & refill order discrepancies for out of state patients• Involved in training & helping to improve training for new employees, designated to help create workflows for the team, & corresponding with other team lead colleagues• Experience with utilizing Salesforce & other CRM help desk platforms such as Zendesk & Freshdesk• Worked on a high volume ticketing queue that required me to answer up to 500 tickets daily• Knowledge in insurance claims processing & prior authorizations discrepancies