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Dynamic and motivated professional with a proven record of generating and building relationships, managing projects from concept to completion, and driven for success. Skilled in building relationships, demonstrating exceptional communication skills, and making critical decisions during challenges. Adaptable and transformational leader with an ability to work independently, creating effective work ethic, and developing opportunities that further establish organizational goals.

Florida International University

Miami Dade College

Credit Analyst

Ernesto Martin III

Cigna Health Spring RX

Credentialing Specialist

Ensure that medical staff members' maintain current credentials and licenses to work legally in their field
Responsible for maintaining active status
Submit insurance billing, process monthly statements, process collection accounts & overdue balances.

Ensured medical professionals were paid appropriately for their services
Work with revenue cycle team to identify gaps in reimbursement
Meet with programs to help direct them with maximizing their reimbursement
Performs cash application duties, reviewing remittance advice forms to verify proper reimbursement
Review patient accounts, identifying potential adjustments for bad debt

Leon Medical Center/ Cigna Health Springs

Member Reimbursement

Answered patient questions on patient responsible portions, copays, deductibles, write-off’s, etc. Resolves patient complaints or explains why certain services are not covered.
Followed up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.
Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
Posts insurance and patient payments using medical claim billing software.

Ernesto Martin III’s posts