1. 1GERARDO RUBEN IRIZARRY
200-23 26 Avenue
Bayside, NY 11360
Cell Phone # (917) 494-2133
E-mail: irizarry6@ yahoo.com
OBJECTIVE: A position in the allied health field as a Medical Biller, Coder or Claims Processor that
will utilize my skills and talents and provide for an opportunity for growth and advancement.
WORK EXPERIENCE:
1199SEIU BENEFIT AND PENSION FUNDS
New York, NY
Technical Quality Reviewer (Claims Auditor)
August 2016-Present
• Audit of Medical Claims for Quality Assurance issues and Claims technical support.
• Monitoring of overpayments and underpayments from Claims Examiners as per claim processing
guidelines.
• Monitoring performance for systems related to all claim processes.
• Track compliance of all policies and procedures of the Medical Claims Department.
• Verification of Eligibility of new and existing members.
ADVANTAGECARE PHYSICIANS P.C. (f/k/a QUEENS LONG ISLAND MEDICAL GROUP),
New York, NY
Claims Analyst
March 2012-August 2016
• Running of reports on legacy QLIMG claims that have been paid but not yet released for payment.
• Audit of claims for potential savings per provider downstream contracts and Letters of Agreements.
• Management of monthly spreadsheets for total savings for the Provider Group.
• Special projects for recoupment recovery.
• Audit of Group Provider Contracts in Qcare.
• Fee Negotiation of claims and referrals for non-participating providers.
• Handling of Letters of Agreement for non-participating providers.
• Follow-up on Letters of Agreement with non-participating providers on status of Fee Negotiations.
• Liaison with insurance company (EmblemHealth) on claims directives.

2. EMBLEMHEALTH, Melville, NY
Professional Correspondence/Reconsiderations Claims Analyst
August 2007-March 2012
• Handling of customer service requests for re-adjudication of claims.
• Processing of written appeals and correspondences for re-adjudication of claims.
• Handling and processing of special reconsideration projects as delegated.
• Processing of pre-existing investigation letters for re-adjudication of claims.
• Void and/or adjustment of medical claims paid incorrectly.
• Processing of medical inpatient and outpatient medical claims for Medicare, Medicaid and
Commercial lines of business.
• Adjudication and repricing of out of area and high-priority aged medical claims.
• Verification of eligibility of new and existing members.
• Training of Claims Analysts on Mulitplan Repricer.
HEALTHCARE PARTNERS, Garden City, NY
Professional Claims Analyst
March 2005-August 2007
• Processing of Medicare, Medicaid & Commercial inpatient & outpatient medical claims.
• Adjudication of high-priority aged medical claims.
• Verification of eligibility of new and existing members.
• Verification of providers within the HIP network of physicians.
• Review of claims for reconsideration to determine if claims should be paid.
• Re-adjudication of claims for overpayment & underpayment.
AMALGAMATED LIFE INSURANCE COMPANY, New York, NY
Medical Claims Processor
April 2004-March 2005
• Processing of outpatient medical and hospital claims for various union plans.
• Verification of eligibility of new and existing members.
• Mailing of correspondences for COB, No-Fault, Workers’ Comp and Subrogation
investigations.
• Repricing of outpatient and inpatient medical and hospital claims from out of state.
• Verification of physicians in various PPO networks via the internet and telephone.
• Handling of Spanish-language customer service calls.

3. FIRST AMERICAN (TRANSAMERICA) REAL ESTATE TAX SERVICE, Melville, NY
Tax Examiner/Information Processor
August 1998- April 2004
• Print out and processing for payment of NYC Real Estate bills and NYC Water bills via an on-line
computer terminal.•
• Print out and analysis of credit and debit ledgers for customer service research.
• Use of assessment file for research.
• Training of other associates with various computer programs.
PHYSICIANS FAMILY HEALTH SERVICE P.C., New York, NY
Administrative Clerk
May 1997-July 1998
• Processed manual billing
• Handled the adjustment of medical carriers’ payments.
• Verified payment of carriers and patients’ outstanding debts over the telephone.
• Scheduled new and existing patients for appointments.•
• Confirmed insurance coverage of patients.
EDUCATION:
QUEENS COLLEGE CONTINUING EDUCATION Flushing, NY
Certificates in Medical Billing, January 2002 and Advanced Medical Billing, June 2003
BERNARD M. BARUCH COLLEGE New York, NY
BBA Computer Information Systems, February 1996
JOB-RELATED SKILLS:
Computer: Microsoft Office, Medical Manager
Claims Processing: E-Z CAP (Healthcare Partners), Qcare (EmblemHealth and ACP/QLIMG)
Coding: CPT-4, ICD-9, HCPCS
Other: Skilled in team environment
Willing to travel
LANGUAGES: Bilingual- English and Spanish
REFERENCES: Furnished upon request