GABRIEL JAUREGUI
El Mirage,AZ
Summary
Organized and dependable candidate successful at managing priorities with a positive attitude. Excellent time management and problem-solving skills. Ability to handle multiple projects simultaneously and maintain accuracy. Adaptable and collaborative team player.
Overview
12
12
years of professional experience
Work History
Administrative Service Officer 1
Arizona Department of Environmental
10.2022 - Current
- Utilize Arizona Procurement Portal for oversight and entry of all requisitions, which includes determining appropriate funding and contracts.
Accounting Specialist 2
Arizona Department Of Emergency & Military Affairs
02.2022 - 09.2022
- Responsible for all tasks associated with accounts payables and receivables
- Receives and disseminates invoices, identifies and resolves invoicing discrepancies
- Conducts research within AFIS and APP to mitigate duplicate payments, receives payment approval from programs and inputs payments into the appropriate procurement and accounting systems, Resolves aging invoices through research
- Resolves billing and payment issues with vendors through thorough research
- Processes and enters all forms of accounts receivable
- Receives inter-agency reimbursement packets for state active-duty missions and processes payments to appropriate state agency
- Receive internal deposits and grant deposits to process inter-agency transfers to appropriate state agency for disaster relief and grant awards.
Billing Administrator
Pro-Pipe
05.2021 - 11.2021
- Complete daily validation of revenue and exporting project data to excel to verify data sets are accurate using basic formulas and critical thinking skills
- Daily entry of production revenue, export data sets from multiple sources into excel to compile and verify billing information is accurate
- Daily entry of production tracking into ERP/Customer Portal/Database
- Verifies accuracy and completeness of data, including revenue balancing, and resolves discrepancies by using standard procedures
Accounts Receivable Reimbursement Analyst
American Vision Partners
11.2020 - 05.2021
- Follows-up with insurance companies and ensures claims are paid/processed, Services each account in priority of importance and independently billing accounts with understanding of all applicable insurance and/or CMS regulations
- Resubmits insurance claims that have received no response or are not on file in a timely manner according to each insurance’s contracted filing limits, Review and appeal unpaid and denied claims, including analysis of coding to assure proper billing
- Makes changes to demographic information as necessary in order to produce a clean claim, Researches and prepares insurance credits for refund approval.
Accounts Receivable Specialist
CVS / Coram Specialty Infusion
03.2020 - 11.2020
- Support Accounts Receivable (A/R) Department with various A/R functions for Specialty Infusion
- Handle the completion of Patient Financial Services (PFS) tasks, including payer follow-up as needed
- Complete PFS tasks include billing and/or accounts receivable follow-up while maintaining quality and productivity requirements
- Build and submit accurate and timely claims to payers, as well as research and analyze unpaid claims and assist in the resolution of denials, partial payments, and payment variances
- Demonstrated experience working with third parties or health insurance payers
- Comfortable crafting professional communications (emails, appeals letters, requests for information) to insurance companies and following through for resolution.
Accounts Receivable Revenue Cycle Coordinator
MedixStaffing / ResCare HomeCare
08.2019 - 02.2020
- Reach out to patients to collect past due payments, monitor account details for non-payment, delayed payments and other irregularities for claims billing, payment validation, insuring proper documentation is obtained and corrections are made for resubmissions and account reconciliations
- Generate regional aging reports and follow up on account resolution for monthly A/R calls with multiple branch’s within five states assigned to my region
- Timely follow up on insurance denials, exceptions or exclusions, conduct thorough research of claim status to identify issues and take corrective measures to obtain payment and ensure accuracy of future claim submissions
- Work closely with payers to determine additional or supportive documentation that may be needed to facilitate prompt payment and provide documentation in a timely manner.
Account Resolution Specialist
Signature Staffing / HeiHealth
03.2019 - 08.2019
- Make necessary arrangements for medical records, additional information requests and proof of documentation as required by insurance payer to review medical necessity, claims reconsiderations and appeals
- Read and interpret insurance explanation of benefits, timely follow up on insurance denials, exceptions or exclusions, conduct thorough research of claim status to identify issues and take corrective measures to obtain payment and ensure accuracy of future claim submissions
- Work closely with payers to determine additional or supportive documentation that may be needed to facilitate prompt payment and provide documentation in a timely manner
- Conduct analysis of denials and partial payments to determine trends that may need to be addressed either in revenue cycle management or with the payer, Ability to learn a variety of systems and maneuver through them daily, including electronic medical record systems and carrier systems
- Perform account reconciliations, research and resolve payment discrepancies and adjustment with attention to detail.
Accounts Receivable
Medix Staffing / Southwest Diagnostic Imaging
08.2018 - 03.2019
- Monitor account details for non-payment, delayed payments and other irregularities
- Review aging claims to ensure compliance and daily production metric standards are met
- Contacts government or commercial healthcare insurance companies to follow up on outstanding accounts, payment errors, corrections and denials for possible resubmission
- Perform account reconciliations, research and resolve payment discrepancies and adjustments with attention to detail
Claims Examiner
Banner Health Corporate
10.2015 - 06.2018
- Adjudicates internal/external claims on a timely basis in accordance with department policies, procedures and standards
- Research resubmitted/corrected claims and pend appropriately, adheres to government guidelines for processing claims
- Refers fee schedule, vendor contract, plan problems or concerns to manager or senior level processors for intervention
- Coordinates requests for provider updates, medical review, enrollment review and coding review
- Troubleshoots, identifies and resolves special handling requirements related to pricing, contracting and system issues
- Processes CMS1500 and/or UB04 claims
Claims Examiner/Customer Service Associate
BlueCross BlueShield
06.2013 - 09.2015
- Processing medical claims and applying correct level of benefits to insure deductible, coinsurance and copays are not over applied
- Accurately process In and Out-of-Network benefits, along with coordinating policies to other commercial, Medicare, Dual BCBS, and senior products plans
- Handle phone inquiries from members or providers with coverage and claim complaints, issues and general questions to give proper amount of knowledge and information to help members to take full advantage of their policies
- Process Medicare Advantage claims according to benefits offered by Banner Health and coordinate provider inquiries, adjustments and appeals through the out of state BCBS plan-to-plan process with Banner Health.
Customer Service Associate
Cigna Voluntary
07.2012 - 06.2013
- Demonstrated ability to listen and respond effectively to customers with complex service issues, confirming eligibility, benefits, claims status and payment research
- Respond to inquiries from members, providers and other entities with information and assistance on group policies
- Assist enrollment center as a swatter signing new members or changing benefits during open enrollment and ensuring members are informed on best options available to fit their needs.
Customer Service Associate
Robert Half / Cigna Voluntary
02.2012 - 06.2012
- To-hire assignment at Cigna Voluntary
- 8 weeks course training on limited benefit policies
- Take ownership of questions by customers to eliminate the need for call backs.
Education
High School Diploma -
University High School
Roswell, NM05.2023
None - Electronic Engineering & Computer Aided Drafting
ITT-Tech
Tempe, AZSkills
- Accounts Payable and Accounts Receivable
- Critical Thinking
- Administrative Support
- Team Goals
- Customer Care
- Operational Efficiency
- Inquiry Requests
- Business Operations
- Office Organization
- Balance Reconciliations
- Microsoft Office
- Payment Collection
- Complex Problem-Solving
- Financial Data Analyzation
Timeline
Administrative Service Officer 1
Arizona Department of Environmental
10.2022 - Current
Accounting Specialist 2
Arizona Department Of Emergency & Military Affairs
02.2022 - 09.2022
Billing Administrator
Pro-Pipe
05.2021 - 11.2021
Accounts Receivable Reimbursement Analyst
American Vision Partners
11.2020 - 05.2021
Accounts Receivable Specialist
CVS / Coram Specialty Infusion
03.2020 - 11.2020
Accounts Receivable Revenue Cycle Coordinator
MedixStaffing / ResCare HomeCare
08.2019 - 02.2020
Account Resolution Specialist
Signature Staffing / HeiHealth
03.2019 - 08.2019
Accounts Receivable
Medix Staffing / Southwest Diagnostic Imaging
08.2018 - 03.2019
Claims Examiner
Banner Health Corporate
10.2015 - 06.2018
Claims Examiner/Customer Service Associate
BlueCross BlueShield
06.2013 - 09.2015
Customer Service Associate
Cigna Voluntary
07.2012 - 06.2013
Customer Service Associate
Robert Half / Cigna Voluntary
02.2012 - 06.2012
High School Diploma -
University High School
None - Electronic Engineering & Computer Aided Drafting
ITT-Tech
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