Roxanne Moreno has over 15 years of experience in medical billing, coding, claims processing, and case management. She is currently a Senior Billing and Claims Administrator at Wellness Connections, where she processes medical claims and ensures legal compliance. Previously, she worked as a Program Coordinator and Claims Specialist at Wellness Connections and as a Case Manager at South Eastern Arizona Behavioral Health Services.

1. Roxanne Moreno Roxannemoreno2012@gmail.com
520-249-7507
P.O. BOX 2711
Sierra Vista, A.Z. 85636
KEY SKILLS
• Excellent communication skills
• Medical Billing and Coding certified
• Peer recovery coach certified
• CPR/First Aid instructor
• Proficient in Excel
• Team-oriented
• Typing skills 45 wpm
• Knowledge of all MS Office applications
• Fast learner
• Adaptable to all work environments
• Demonstrates leadership qualities
• Highly organized & self-motivated
• Billing/Clerical/Administration functions
• Customer Service skills
• Marketing skills
• Understanding of and the sensitivity to the needs of adults with
psychiatric disabilities.
• Demonstrate a commitment to a recovery philosophy.
• Ability to interact effectively and positively with a diverse population.
• Ability to operate a 10-14 passenger van.
• Ability to travel within local area and statewide as required for
meetings and trainings (i.e. Sierra Vista, Tucson, Phoenix, etc.)
• Ability to maintain confidential information (oral, written, electronic),
according to HIPAA rules.
• Ability to work as a team member, as well as in a supervisory capacity.
• Strong knowledge of community resources.
• Ability to effectively carry out multiple and diverse tasks
simultaneously.

2. Experience
Wellness Connections
Sr. Billing and Claims Administrator
November 2015-Present
• Determines covered medical insurance losses by studying provisions of
policy or certificate.
• Establishes proof of loss by studying medical documentation;
assembling additional information as required from outside sources,
including claimant, physician, employer, hospital, and other insurance
companies; initiating or conducting investigation of questionable
claims.
• Documents medical claims actions by completing forms, reports, logs,
and records.
• Resolves medical claims by approving or denying documentation;
calculating benefit due; initiating payment or composing denial letter.
• Ensures legal compliance by following company policies, procedures,
guidelines, as well as state and federal insurance regulations.
• Maintains quality customer services by following customer service
practices; responding to customer inquiries.
• Provides legal support by assembling documentation for settlement
action.
• Protects operations by keeping claims information confidential.
• Prepares reports by collecting, analyzing, and summarizing
information.
• Updates job knowledge by participating in educational opportunities;
reading professional publications; maintaining personal networks;
participating in professional organizations.

3. • Accomplishes organization goals by accepting ownership for
accomplishing new and different requests; exploring opportunities to
add value to job accomplishments.
• To include but not limited to:
Claims Adjustment, Financial Software, Documentation Skills, Data Entry Skills,
Analyzing Information, Problem Solving, Verbal Communication, Customer
Focus, FDA Health Regulations, General Math Skills, Statistical Analysis
Program Coordinator
October 2013-November 2015
• Assist with the planning of outings and events, as needed.
• Work closely with the Program Manager to coordinate the design and
implementation of programs and activities, while ensuring consumer
input and involvement in all aspects of the program.
• Work directly with center participants, staff, and volunteers to ensure
participant needs are being met to organization standards.
• Develop and maintain positive, productive working relationships with
staff, participants, and volunteers, as well as community partners.
• Ensure referrals are reviewed for accuracy and completeness;
interface with referring agencies to ensure proper referral and clinical
documentation is received in timely manner;
• Build positive working relationship with community agencies.
• Ensure internal controls are followed with regard to proper
documentation, maintenance and storage of member records.
• Assist in preparation for data validation and other audits.
• Prepare and maintain program documentation; submit required reports
in a complete and timely manner.
• Work closely with the Program Manager to assist with recruiting,
screening, orienting, and supervising staff and volunteers, as directed.
• Track and maintain program referral, enrollment, eligibility status,
participation, and outcome data.
• Deliver 1:1 and group peer support, skills training and health promotion
services as needed.
• Ensure Transportation needs of members are met according to
program guidelines.
• Assist participants with issues of advocacy and grievance.
• Ensure appropriate implementation of new curricula; identify staff
training needs.

4. • Gather, review, and file daily participant progress notes for billing.
Submit all billing paperwork to administration.
• Other duties as assigned.
Claims Specialist
September 2009-October 2013
• Determines covered medical insurance losses by studying provisions of
policy or certificate.
• Establishes proof of loss by studying medical documentation;
assembling additional information as required from outside sources,
including claimant, physician, employer, hospital, and other insurance
companies; initiating or conducting investigation of questionable
claims.
• Documents medical claims actions by completing forms, reports, logs,
and records.
• Resolves medical claims by approving or denying documentation;
calculating benefit due; initiating payment or composing denial letter.
• Ensures legal compliance by following company policies, procedures,
guidelines, as well as state and federal insurance regulations.
• Maintains quality customer services by following customer service
practices; responding to customer inquiries.
• Provides legal support by assembling documentation for settlement
action.

5. • Protects operations by keeping claims information confidential.
• Prepares reports by collecting, analyzing, and summarizing
information.
• Updates job knowledge by participating in educational opportunities;
reading professional publications; maintaining personal networks;
participating in professional organizations.
• Accomplishes organization goals by accepting ownership for
accomplishing new and different requests; exploring opportunities to
add value to job accomplishments.
South Eastern Arizona Behavioral Health Services
Case Manager/Benefits specialist
March 2007-September 2009
• Scheduling appointments for intake
• Verifying insurance including third party
• Preparing core assessments
• Coordinating services after intake
• Renewing ISP’s and contacting clients regularly
• Financial updates with client
• Coordination of care
• Tracking referral to intake timeframes
• Making psych evaluation appointments for member
• Referring member out to community resources
• Coordinating family team meetings

6. Texas Treasures Magazine
Sales Manager
October 1993 –December 2006
• Assigned duties and established business contacts
• Contracted with printing companies
• Did employee evaluations
• Supervised 8 employees
• Improved the billing and collection system
• AP/AR/Payroll
• Directed sales team to produce more effectively
• Developed better strategies to reduce waste in print costs
• Administered pay checks and bonuses
• Balanced our budget and saved the company waste
• Forecasted yearly budget
• Motivated my team to grow by 45% under my direction

7. Texas Treasures Magazine
Sales Manager
October 1993 –December 2006
• Assigned duties and established business contacts
• Contracted with printing companies
• Did employee evaluations
• Supervised 8 employees
• Improved the billing and collection system
• AP/AR/Payroll
• Directed sales team to produce more effectively
• Developed better strategies to reduce waste in print costs
• Administered pay checks and bonuses
• Balanced our budget and saved the company waste
• Forecasted yearly budget
• Motivated my team to grow by 45% under my direction