Rosanna Espinosa

22 Van Buren Avenue, Carteret, New Jersey 07008

(201)686-4366
rcespinosa@hotmail.com

QUALIFICATIONS PROFILE
Visionary, innovative and performance-driven professional offering 15 years of p
rogressive career in assuming various management and supervision roles. Demonstr
ated record of success in analyzing viability of business ideas, developing crea
tive strategies to meet goals and ability in executing processes that significan
tly generate positive results on time, under budget, and beyond expectations. Re
cognized leader who is adept at setting goals, coordinating, developing and mana
ging operations for clinical, financial/accounting, administrative, IT and HR ac
tivities.
- Known for excellent talent in leveraging efficiency, management and quality pr
ocesses.
- Proven effective thinker; accustomed to fostering positive working environment
and openly embraces diverse backgrounds and experiences.
- Proficient in using Microsoft Suite, WordPerfect, Call Tracking, Comtron Syste
m, Amisys System, iCare/ iView, ProClaim, QuickBooks Pro / Peachtree, Benefits A
ccess, ICMS System, Power MHS, CIRF, ICD-CM/CPT Coding, and various medical offi
ce procedures.
- Bilingual in Spanish and English languages.

CORE COMPETENCIES :
- Business Development
- Organization/Multi-Project Management
- Persuasive Communicator
- Organization needs assessment/analysis
- Strategic and tactical planning
- HRIS technology
- Human Resource Systems Alignment
- Training/Development
- Performance Assessment
- Project Management
- Business and Account Development
- Compensation/Benefits
- Strategic / Financial Planning
- Customer needs assessment

SUMMARY OF EXPERIENCE
LEADERSHIP AND SUPERVISION
- Conducted effective customer service leadership programs through managing the
Shipping Department and all the data entry processes.
- Managed the practitioners and vendor’s contract data entry into all CIGNA transact
ional platforms.
- Streamlined prior authorization process by handling all inbound phone calls.
- Sorted cases for approval, procedure status that needs prior authorization and
performed case referral for clinical follow-up.
- Ensured the compliance of referrals medical authorization with the CIGNA Healt
hCare policies, procedures, documentation and requirements.
- Led the preparation of accounts payable and receivables for all locations.
- Supervised all reports and provided assistance to managers in performing vario
us departmental functions
- Directed the provider’s claim submission and contracts review.
HUMAN RESOURCES
- Performed human resources functions, which include handling accounts payables/
receivables and department collections.
- Mentored providers on health plan products and facilitated application process
for providers.
- Performed document verification for accurate insurance payments.
- Conducted cash reconciliation, credit and insurance payments.
- Handled the entire past due accounts and sustained all reports.
- Rendered training to newly hired employees.
COLLABORATION AND CUSTOMER RELATIONS
- Negotiated with matrix partners in regard to practitioner and vendor’s demographic
and reimbursement set-up.
- Established and sustained harmonious business relationships with physician, pr
oviders and practice manager.
- Provided superior quality service to clients through continuous communication
with provider on the company’s policies and procedures.
PROCESS CONCEPTUALIZATION AND IMPLEMENTATION
- Efficiently addressed complaint and issues that arose in each account to maint
ain the department’s positive workflow.
- Ensured and emphasized physician’s data’ quality, accuracy and efficiency within a com
plex database.
- Served as primary point of contract in claim research issue resolution.
- Efficiently resolved provider’s complaints and disputes; ascertained the adherence
of all services with the company’s policies and procedures.

EMPLOYMENT HISTORY
KAPITAL FREIGHT SOLUTION INC. ~ Avenel, NJ ~ 2006-2010
SUPERVISOR
VIP OPTICAL LAB / PARTNERS IN VISION ~ Linden, NJ ~ 2005-2006
CUSTOMER SERVICE MANAGER
CIGNA HEALTHCARE ~ New Jersey, NJ ~ 2002-2005
PROVIDER DATA MANAGEMENT SENIOR ASSOCIATE - PENDED CLAIM UNIT
PROVIDER RELATIONS SENIOR ASSOCIATE – 16 States
STATE EXPERT (Ohio Network – 4 States)
HEALTH SERVICE SPECIALIST (3 States)
ADVANCED VISION CARE ~ North Bergen, Vernon, NJ ~ 1997-2001
OFFICE MANAGER (2 Sites)
ATLANTIC PACIFIC TEA COMPANY ~ New Jersey City, NJ ~ 1995-1997
FRONT–END SUPERVISOR

EDUCATION
DIPLOMA IN BUSINESS ADMINISTRATION AND COMPUTERIZED ACCOUNTING ~ 2002
HoHoKus Hackensack, School of Business and Medical Sciences (Formerly American B
usiness Academy) ~ Hackensack, NJ
MEDICAL CLERICAL ASSISTANT CERTIFICATE ~ 1997
The Cittone Institute ~ New Jersey City

ACHIEVEMENTS
- Received, Certificate of Achievement ~ Health Services, Department of Recognit
ion, 2003
- Received, Certificate of Achievement ~ Provider Resolution, Department of Reco
gnition, 2004