Avatar of Ernesto Martin III.

Ernesto Martin III

Credit Analyst
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.
Cigna Health Spring RX
Florida International University

Skills

Ability to learn and adapt to new software technologies
maintain confidential information
Extremely proactive with a strong bias for action; well-developed sense of urgency and follow through
Documentation and organization skills
Strong negotiating
influencing
analytical and facilitation skills
Excellent internal/external communication skills

Languages

English
Native or Bilingual
Spanish
Native or Bilingual

Work experiences

Credentialing Specialist

Cigna Health Spring RX

Jan 2020 ~ Present
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.

Member Reimbursement

Leon Medical Center/ Cigna Health Springs

Jan 2019 ~ Jan 2020
1 yr 1 mo
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

Balance Billing

Leon Medical Center/ Cigna Health Springs

Jan 2017 ~ Dec 2018
2 yrs 0 mos
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.

Educations

Florida International University

Bachelor’s Degree
Political Science

2020 - 2022

Miami Dade College

Associate’s Degree
Political Science

2015 - 2018
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