Jafet

Demonstrated experience with Insurance Verification.

Demonstrated experience with Reimbursement Support.

Demonstrated experience with Benefits Investigation.

Demonstrated experience with Data Management & Accuracy Control.

Demonstrated experience with Workflow Optimization.

Conduct benefits investigations in a medical device environment, verifying insurance coverage and reimbursement eligibility for advanced wound care products, including PICO negative pressure wound therapy and Centrio.. Support reimbursement cases for patients with complex wound conditions, including chronic ulcers, oncology-related wounds, and radiation-induced skin injuries.. Research payer policies and coverage criteria, coordinating with healthcare providers and payers to gather documentation supporting timely authorization and reimbursement decisions.. Maintain accurate, audit-ready case documentation in compliance with HIPAA and healthcare regulatory standards.

Reviewed and updated account information, balances, and documentation to ensure records accurately reflected current status, mirroring the account-review and balance-update workflows required in vendor and patient-billing reconciliation.. Coordinated with insurance companies to verify coverage and obtain pre-authorizations, supporting timely and accurate account resolution.. Developed and maintained operational procedures that enhanced workflow efficiency and supported consistent, audit-ready documentation.. Collaborated with area managers to evaluate operational needs, optimize plans, and support smooth transitions across teams and processes.. Managed high-volume data uploads with strict accuracy control, supporting reconciliation across multiple systems.. Championed HIPAA-aligned operational practices to safeguard patient data while scaling workflows for future growth.

Executed trust & safety protocols to ensure compliance, detect violations, and manage high-risk incidents in line with company Code of Conduct and policy standards.. Collaborated with legal, compliance, and product teams to align enforcement practices with regulatory requirements and emerging risk trends.. Supported data-driven decision-making by identifying behavioral trends and recommending policy updates, and spearheaded risk assessments and contingency protocols to ensure uninterrupted operations during unforeseen events.

Reviewed and edited daily allocation figures to verify the accuracy of entries prior to processing, directly supporting account-reconciliation accuracy.. Managed high-volume, high-accuracy data entry and document uploads within healthcare staffing and billing systems.. Identified risk and opportunity potential to develop mitigation planning and support continuous process improvement.. Maintained discretion and confidentiality when handling sensitive patient and vendor records.

Delivered bilingual customer support, handled escalations efficiently, and maintained top satisfaction ratings.. Responded to inbound inquiries and researched account details to resolve issues within service-level expectations.