Alejandra Delgado
Bentonville,AR
Summary
Dynamic professional with extensive experience in patient coordination and case management. Proven ability to enhance patient satisfaction through effective communication and financial consultations. Skilled in data entry, and proficient in Epic, Dentrix, and Denticon, demonstrating adaptability and a positive attitude in fast-paced environments. Committed to achieving optimal outcomes for patients and practices.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Front Desk Administrator / Treatment Coordinator
McShane Oral & Maxillofacial Surgery
Centerton, AR
03.2025 - Current
- Process incoming patient data into the system, including demographic information, referrals, x-rays, and insurance coverage details.
- Draft, submit, and track claims for reimbursement from insurance companies.
- Input data into various software programs accurately and efficiently.
- Answer incoming calls from patients and referring offices.
- Coordinate with patients, staff, and physicians to ensure accurate scheduling of surgeries.
- Conduct financial consultations with new and existing patients when new treatment plans are presented.
- Interpret verbal and written conversations between individuals with limited English proficiency.
- Handle cash register duties, including processing payments and issuing change.
- Input and process daily claims and pre-authorizations.
Case Manager I
Walmart Claims Management
07.2024 - 01.2025
- Lead claim investigations by conducting ongoing medical and legal reviews, commissioning field investigators and cause and origin specialists to determine claim origination, managing media exposure during investigations, synthesizing information from outside counsel, and reviewing, documenting, and indexing information received on each claim in the claim/image management system.
- Handle the monetary aspects of assigned claims by establishing reserves within the approval level, notifying store managers of significant reserve increases, monitoring reserves for all open claims, authorizing payment for approval or facilitating the denial of the claim, and reserving files for payments that exceed the authority for the manager and serious case review.
- Minimize legal exposure by securing services of outside legal counsel; attending and participating in arbitration's; auditing and paying outside counsel invoices
- Manage approximately 80 moderately complex cases involving alleged bodily injury, personal injury, and property damage by interviewing key witnesses, securing evidence, analyzing evidence, reviewing applicable laws, interpreting medical reports, deducing causes and responsibilities, documenting case details, determining whether payment is warranted, and managing multiple claims related to a single event as required.
- Manage the interpretation of medical reports and case information; review records for preexisting conditions; reference applicable case law and statutes; and present claim reviews and decisions to senior management for approval or guidance.
- Manage negotiations with the customer, the customer's attorney, or a third party to resolve claims by sharing investigative results and rationale; listening to the claimant's perspective and arguments; influencing the claimant's perspective; and coming to a consensus on the appropriate and final resolution.
Treatment Coordinator
Walmart Health
Rogers , AR
06.2021 - 06.2024
- Conducts patient interviews to understand the patient's oral health histories, concerns, and objectives; explaining treatment plans to patients; addressing patient concerns and answering patient questions; assisting patients in treatment priorities; and establishing plans for scheduling and payments
- Conducts financial consultations with new and existing patients when new treatment plans are presented; understanding the practice policies on working with dental benefit plans; and educating patients on available dental benefits
- Handling insurance information for claim rejections and providing requested documentation
- Introduces new patients to the practice by reviewing health histories, explaining dental examinations, and describing other features about the practice
- Greets and checks patients in and out before and after treatment; answering incoming calls (for example, new patient calls, emergency calls, appointment scheduling requests, records requests, patient follow ups)
- Develops, communicates, and implements processes and practices to meet business needs by collaborating with managers, co-workers, customers, and other business partners; analyzing and applying information from multiple sources; monitoring progress and results; and identifying and addressing improvement opportunities
- Interpreting for patients and providers
- Provided customer service for inbound and outbound calls
Patient Coordinator
Rock Family Dental
07.2020 - 06.2021
- Checking patients in/out, scheduling appointments, updating patient demographics
- Verifying and creating insurance plan profiles, breakdowns
- Maintain customer accounts and record account information
- Cashier-taking payments from patients
- Handling of facility daily deposits
- Sending patient referral information, records to other clinics
- Medical Interpreter- interpreting for Spanish speaking patients
- Presenting patients with treatment plans and payment options
- Provided customer service for inbound and outbound calls
Medical Support Representative
Mercy
12.2018 - 07.2020
- Receptionist-checking patients in/out, scheduling appointments, updating patient demographics (verifying insurance information for payment)
- Cashier-taking payments from patients, handling of daily facility deposits
- Responsible for sending and receiving messages from patients
- Medical Interpreter- interpreting for Spanish speaking patients
- Complying with procedures, rules, and regulations on keeping a safe and clean reception area
- Provided customer service for inbound and outbound calls
Seasonal Cashier
Hobby Lobby
10.2018 - 12.2018
- Handle cash, credit or check transactions with customers
- Issue change, receipts, refunds, or tickets
- Count money in cash drawers at the beginning and end of shifts to ensure that amounts are correct and that there is adequate change
- Resolve customer complaints, guide them and provide relevant information
Account Executive
Worldpay Us
02.2017 - 02.2018
- Marketing/Recruitment of new merchants to sign for service
- Install payment processing devices
- Maintain current merchants up to date with new programs
- Assist merchants when issues come up, in and out of town
- Report daily opportunities to manager
- Provided customer service for inbound and outbound calls
Deputy Court Clerk
Bentonville District Court
06.2016 - 10.2016
- Taking payments for defendants/issuing payment extensions
- Entering citations and scheduling court dates
- File clerk
- Provided customer service for inbound and outbound calls
- Forwarding case information to attorneys
- Background record checks for employment
Education
Healthcare Interpreter Program -
Cordova Educational Programs
Rogers, AR01.2014
Patient Care Assistance Program -
Northwest Arkansas Community College
Bentonville, AR01.2009
Certified Nursing Assistant Program -
Northwest Arkansas Community College
Bentonville, AR01.2009
Skills
- Positive attitude and enthusiasm
- Administrative support
- Customer service
- Time management
- Communication
- Adaptability
- Spanish medical and dental interpreter
- Proficient in Microsoft Word, Microsoft Excel, and Microsoft Outlook
- Proficient in Epic, Dentrix, Denticon, and Braid programs
- Billing processes
- Case management
- Data entry and analysis
- Transaction monitoring
Certification
Texas Department of Insurance - Insurance Adjuster - All Lines License Number:3215933
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
Timeline
Front Desk Administrator / Treatment Coordinator
McShane Oral & Maxillofacial Surgery
03.2025 - Current
Case Manager I
Walmart Claims Management
07.2024 - 01.2025
Treatment Coordinator
Walmart Health
06.2021 - 06.2024
Patient Coordinator
Rock Family Dental
07.2020 - 06.2021
Medical Support Representative
Mercy
12.2018 - 07.2020
Seasonal Cashier
Hobby Lobby
10.2018 - 12.2018
Account Executive
Worldpay Us
02.2017 - 02.2018
Deputy Court Clerk
Bentonville District Court
06.2016 - 10.2016
Healthcare Interpreter Program -
Cordova Educational Programs
Patient Care Assistance Program -
Northwest Arkansas Community College
Certified Nursing Assistant Program -
Northwest Arkansas Community College
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