Rowel John Orellano

Hunterdon Medical Center New Jersey

• Claims Follow-Up:
  Monitor and follow up on unpaid or denied claims.
  Communicate with insurance companies to resolve outstanding claims.
• Payment Posting:
  Accurately post payments, adjustments, and denials into billing systems.
• Appeals and Denials Management:
  Research and appeal denied or underpaid claims.
  Ensure claims comply with payer policies and regulations.
• Patient Account Management:
  Resolve patient billing issues.
  Handle incoming inquiries and explain insurance coverage.
• Reporting:
  Generate aging reports.
  Track collection status and trends.

• Inbound inquiry regarding the claims status, eligibility and benefits of the member
• Responsible to walk through credentialing status with Devoted Health
• Assist providers on how to submit an appeal or dispute in case they don’t agree with the determination of the claims
• Proactive informing providers if they need to submit prior authorization or referral to see a specialist
• Processing initial credentialing and re-credentialing applications
• Screening practitioners’ applications and supporting documentation to ascertain their eligibility
• Identifying discrepancies in information and conducting follow-ups
• Presenting applications to the facility’s Credentialing Committee
• Assisting customers with credentialing inquiries
• Responding to health plan provider inquiries
• Capturing primary source documentation in computer databases
• Ensuring data is backed up and ensuring compliance with applicable laws, regulations, procedures, and policies
• Process on-boarding of new providers and enrollment via web portal for contract negotiations
• Conducting follow up of application status if provider is ACTIVE, IN-PROGRESS or NEED COMPLIANCE
• Update those expired documents like board of certification, DEA, CDS, license state and Mapracstate etc
• Update CAQH files and rosters given from the payer accordingly.

• Proven ability to learn quickly and adapt to new situations
• Identified issues, analyzed information and provided solutions to problems
• Paid attention to detail while completing assignments
• Developed strong communication and organizational skills through working on group projects
• Assisting customers on how to reset their password in case they are locked out