Carlos Urrutia has over 10 years of experience in medical claims and customer service, currently working as a Senior Account Specialist at HealthSpan Incorporated. He is fluent in Spanish and has worked in several roles processing workers' compensation claims and customer service at Sedgwick Claims Management Services and Univenture Incorporated. Urrutia has education in business management and pre-radiology.
Assisting with patient registration, Schedules, confirms payments, and verifies patient appointments and insurance information. Receives and directs phone calls, patients, and other visitors.
Manage concierge as well as the PBX Operators. Guest Relation Coordinator is responsible for Daily admission reports, new and existing patients, discharge reports, referrals, Doctors Orders, Emergency Codes, scheduling and coordinates appointments, employee scheduling, payroll, medical records (ICD-9) work very closely with case management
Assisting with patient registration, Schedules, confirms payments, and verifies patient appointments and insurance information. Receives and directs phone calls, patients, and other visitors.
Manage concierge as well as the PBX Operators. Guest Relation Coordinator is responsible for Daily admission reports, new and existing patients, discharge reports, referrals, Doctors Orders, Emergency Codes, scheduling and coordinates appointments, employee scheduling, payroll, medical records (ICD-9) work very closely with case management
1. Carlos Urrutia
Fairfield, OH
513-704-8186
Email Address: cubgcincy11@yahoo.com
SUMMARY
Accomplishedmedical professional withover10 yearsof medical claims/worker’scompensationand
customerservice experience.
FluentinSpanish.Exceptional attendance andpunctualityrecordthroughoutmycareer.
PROFESSIONAL EXPERIENCE
HealthSpan Incorporated: 2015 to present
Office location: Cincinnati, OH
Senior Account Specialist (SAS)
Provides multiple levels of support with Customer service, Employer groups, Medical
management, maintenance of Data base, Third Party Administrators and varies Network
communication avenues.
Manages UR telephone queue line, incoming faxes, voice mail, processing of MD
reviews and Claimreviews including other inquiries identified with resolution of the
request as well as managing Utilization referrals.
Work collaboratively with Care Management nurses and assist other departments
within HealthSpan as needed.
SedgwickClaimsManagementServices,Incorporated: 2008to 2015
Office Location: Cincinnati,OH
Home Office: Dublin,OH
Trained and heldthe followingfourpositionswithinSedgwick,to fulfill the company’s needs:
ClaimsLiabilityAssociate Self-FundedKrogerAccount (2013-2015): Licensedasa PropertyandCasualty
Adjusterinthe statesforwhichI wasresponsible.
Gatheredinformationtodetermine liabilityexposureof the store,whichconsisted of bodily
injury and/orpropertydamage.
Assigned reserve valuestoclaims,made claimpaymentsasnecessaryandsettledclaimsupto
designatedauthoritylevel orauthorizationfromsupervisor.
Managed subrogationof claimsandnegotiatedsettlements.Communicated claimactionwith
clientwithproperdocumentationandclaimscoding.
SpecialtyOperationsCoordinator-State Fund(2012-2013): Analyzedandprocessedlow-and-midlevel
workerscompensationclaimstodeterminebenefitsdue andensuredongoingadjudication of claims
withincompanystandardsandindustrybest-practices.
Processed workerscompensationclaims (reviewed compensability),benefitsdue,andfiled
necessarydocumentationwithstate agency.
Co-ordinated actuarial/settlementissues thatimpacted employers withrate andsettlement
departments.
2. Carlos Urrutia (513)704-8186
CustomerService Representative I:National Bill Review(2008-2010 & 2011-2012): Actedas primary
liaisonwithcustomerstelephonically;performed necessaryresearchtohelpresolvebillingissueswith
providers,claimsexaminers,employersandinjuredworkers.
Handledall Spanishcallsinthe department.Educatedandinformed the customeraboutthe
documentationrequiredtoprocessabill,requiredtime frames,paymentinformationandbill
status.
ClaimsExaminer I-Departmentof Administrative Services-Mental HealthInstitutions-MCOinour
Cincinnati office (2010-2011). Processed Medical onlyclaims, contactedthe injuredWorkers,
EmployersandProviders.
ReviewedC-9treatmentrequests,fromproviders,thatdeterminedthe appropriate decisionfor
approvedC-9’s,or staffed treatmentrequestswithNurse Case Manager,forfurther
determination.
Continued communicationwiththe OhioBureauof Worker’sCompensationandfellow team
members.
Ensureda highlevel of qualityandefficiencyof processed claims.
UNIVENTURE,INCORPORATED: 2006 to 2008
Office Location: Marysville,OH
WebSalesCoordinator: Managed flow of telephonicandinternetordersandassisted
customersinplacingandupdated ordersandinformation.
CustomerService Representative/SalesRepSupport:Wrote orders,quoted andfollowed up
withcustomersonorders.Calculated shippingcostsandupdatedinformationintothe database
on customeraccounts.
Workedcloselywiththe MarketingDepartmentwith companiesinCentral andSouthAmerica
withSpanishTranslation.
Education:
The School of Radiology
Marion Technical College:
Pre-Radiology
ColumbusState CommunityCollege:
BusinessManagementProgram
PanamaCanal College:
Additional Training: CompletedLeadsProgram (Leadership) and ClaimsExaminer I SelfInsured
Program through SedgwickCMS University.
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