1. Ramona Parra
Miami, Fl 33145
(646)-379-9492
Parra.Ramona06@gmail.com
SUMMARY OF QUALIFICATIONS:
A skilled Bilingual Healthcare professional with a myriad of experience. This includes but is not limited to Medicaid
recertification, Government Healthcare regulations, and Enrollment/Eligibility requirements. With years of service in
Quality Assurance,Auditing, Claims Adjudication, Medical Billing, Customer service and Administrative support in the
Health care industry.
CAREER EXPERIENCE:
Jacobson Group - Blue Cross Blue Shield, Phoenix, Arizona-
Enrollment Coordinator/Claims specialist - contractor, November 14 - Present
 Reviewed existing applications.
 Verified Demographics changes and updated.
 Reviewed subsidies amount or cost reductions allow by government’s programs.
 Claims Reviewer, worked a pending report for Dentals/Medical Claims for Federal Employees.
 Verified Paid and unpaid Claims for final adjustment.
 Reviewed grievance, appeals and unpaid claims over 30 days.
 Approving, rejecting and adjusting professionals claims according policies and procedures.
CenterLight Healthcare New York, NY
Entitlement Coordinator/Enrollment Specialist - contractor, April 2014 – November 2014
 Reviewed Medicaid recertification date and contacted patients to assist with enrollment.
 Tracked all recertification submitted.
 Verified addresses of patients with social worker on staff.
 Performed outreach efforts by contacting relatives of patients to confirm whether they were insured.
Affinity Health Plan New York, New York
Membership Accountant – Enrollment Specialist, June 2012 – October 2013
 Evaluated, processed and routed new and recertification enrollment applicants.
 Processed inquiries of local department of Human Resources Administration.
 Worked cooperatively with colleagues to contribute to the success of marketing and membership.
FidelisCare NY, New York, New York
Eligibility Associate, November2010 – May 2012
 Performed quality assurance by ensuring all Medicaid, Family Health Plus, and Child Health Plus application
adhered to the regulations of FidelisCare New York, State Department of Health policies and requirements.
 Maintained on-going outreach efforts to FidelisCare members to verify accuracy of information provided on
applications.
Authorization Specialist, May 2009 – November 2010
 Processed authorizations based on request received via telephone, written (mail or fax) submitted from primary
care physicians, specialists, hospitals, and ancillary providers.
 Referred questionable coverage issues or issues requiring additional clinical review to appropriate clinical staff.
 Coded all diagnoses and procedures using ICD-9 and CPT coding manuals.
Member Service Representative, November 2007 – May 2009

2.  Served as a liaison between FidelisCare and its member to facilitate access to care coverage,eligibility and
complaints.
 Provided exceptional customer service to ensure member satisfaction and retention.
Center Care/Fidelis Care of New York
Claims Examiner, June 2003 – November 2007
 Answered and documented telephone calls inquiries from Physicians and/or Physician’s representative.
 Reviewed specific medical claims such as; durable medical equipment (DME), radiation, chemo, I.V. therapy, and
physician services.
 Approved and denied invoices received from affiliated and non-affiliated providers in accordance with
geographical location and contractual agreements.
Other Employers:
VITAs HealthCare, Florida
Health Insurance Plan Administrators (HIPA), Florida
Heritage South East Medical Group, Florida
Prime Care Health Plan, Florida
Pasteur, Florida
EDUCATION:
Bachelor of Science in Human Service
Major: Health Service Administration
University of Phoenix, Currently Pursuing
SKILLS
 Proficient in all Microsoft Office Suite 2010. Proficient in Spanish • Ez-Cap (1.3)
• Billing and accounts receivable (BAR) • QCARE• IDX • Termite • CSC• ECM • Facets (5.5)
• Publisher and Platinum.AmysisVATtack,TPS,Parameter matrix and Image retriever.
***References Available on Request***