ANA B. AMADOR
Bronx,USA
Summary
Strive to exceed expectations by delivering superior performance. To obtain a challenging and rewarding position in a company where I can continue to grow as a professional. Maintain leadership trust in all initiatives and interactions. Continue to provide an award-winning track record in a challenging environment and being self-motivated to go above and beyond in all aspects of my career. Embrace every challenge with a positive attitude and determination to succeed.
Patient-focused professional equipped with administrative and customer service expertise. Helps keep healthcare services proceeding smoothly by coordinating communications, referrals, and policy enforcement. Talented in finding balanced solutions and resolving conflicts.
Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.
Flexible hard worker ready to learn and contribute to team success.
Overview
16
16
years of professional experience
Work History
Member/Patient Services Representative
Medix Staffing Solution/Villagecare Max
New York, USA
04.2024 - Current
- Handling incoming telephone calls and answering questions for members and providers
- Make outgoing calls when required to providers, and vendors
- Assisting members in accessing all necessary covered and non-covered services in conjunction with plan of care
- Data entry specialist for authorizations under the direction of the Care Management Supervisor
- Arrange appointments with physicians and other health care provider services
- Assist members in selection of participating providers that will help them improve the quality and outcomes of care
- Verify health insurance coverage through ePaces and Care Management System while entering new authorizations for enrollees prior to the enrollment effective date, ensuring appropriate coding of services
- Assist Care Managers and submit prior authorization for home health care services, DME (durable medical equipment), inpatient/hospital admissions prior authorizations
- File/Submit Grievance and appeals for members and verifying all clinicals are in file before submission
ASSISTANT PROGRAM MANAGER, FAMILY CAREGIVERS
04.2021 - 10.2023
- Manage, motivate, direct, train, evaluate, participate in the hiring process, and discipline all team members effectively
- Assist with unresolved issues between; staff, clients and/or departments
- Direct team meetings at least twice a month on a needed basis
- Attend virtual training to improve skills and knowledge relevant to the position
- Assist program director by participating in creating functional strategies and specific objectives, developing budgets/policies/procedures
- Ensure compliance and quality assurance with the agency and state policies and procedures for the adult foster care and group adult foster care programs
- Perform other tasks or special projects assigned by the Program Director, CEO, and other senior staff
- Manage program tools in place to ensure scheduling is being completed to allow accurate billing, payroll and accounts receivable records
- Maintain positive partnerships with providers and clinics
- Assist billing department with inquiries/denials related to system scheduling, authorizations, etc
- As the first point of contact
- Conduct OIG (Office of Inspector General) monthly reports
BILLING COORDINATOR / ADMINISTRATIVE ASSISTANT
Family Caregivers
08.2017 - 03.2021
- Office clerk duties answering phone calls, filing documentations, faxing, emailing, scanning, uploading, etc
- Intake information of prospective clients/patients
- Health Insurance eligibility and verification for requested services
- Assist adult foster care and home health aide program coordinator when needed
- Creating and managing clients' accounts/files
- Manage authorizations/notifications and other services requests received for referrals via incoming calls, emails, faxes, and other submissions
- Electronically prepare and submit data and claims to insurance companies by using a variety of billing software
- Ensure processing of payments from insurance companies
- Maintain billing and payment status records by managing accounts receivable reports accurately
- Maintain billing software by updating rate changes, cash spreadsheets, and current collection reports
- Reconciling account discrepancies by investigating and appealing denied claims
- Planning and supervising billing and collection operations
- Answer questions and solve problems regarding billing activities
- Examine and audit billing systems to ensure accuracy and request any missing client information
- Processing payer remittances
- Accurately processing payroll and billing patient claims in accordance with payer requirements and organization policy
- Train and ensure that billing clerks are performing accurate data entry services
CUSTOMER RELATIONSHIPS MANAGER
Bank of America / DISYS
06.2011 - 07.2012
- Company Overview: (CONTRACT)
- Managed a large portfolio of customers throughout default servicing whether it was retention or liquidation options
- Expertise in loan modification specific to the investor segment, serving as a single point of contact and trusted advisor
- Had to oversee a broad set of activities including, load modifications, document validation, NPV, modeling, 2nd mortgage modification, short sale/DIL, and answered technical foreclosure questions
- Documented notes into customer-facing systems and monitor accounts for trail payments, lengthy repayment plans, and special forbearances
- Clearly communicated the customer's status and steps that were required for the bank to make a Fair, Fast and Final decision
- Continuously met established performance metrics such as answering and returning calls, quality and loan activities
- Build internal relationships and work closely with other departments to create a great customer service experience for the customer
- Completed collection calls for trail payments and modified payments, determined if a loan qualified for a forbearance or moratorium
- (CONTRACT)
LOSS MITIGATION SPECIALIST
Neighborhood Assistance Corporation of America
11.2009 - 05.2011
- Company Overview: (HUD APPROVED)
- Collected and reviewed necessary documents to complete a financial package to determine members eligibility for a loan modification
- Analyzed financial packages for completion of documentation
- Reviewed files for other possible solutions such as forbearance or moratoriums
- Determined ability to pay using cash flow analysis and debt ratio
- Submitted and negotiated files to mortgage companies (Bank of America, Chase, Wells Fargo, HSBC, etc..) for members seeking assistance through Home Save Program
- Submitted foreclosure postponement request to time for the review process
- Educated and set up expectations for the members of foreclosure sale prevention methods
- Assisted Spanish speaking members as a counselor and translator
- Complied with guidelines for major investors such as Fannie Mae, Freddie Mac, FHA and VA
- (HUD APPROVED)
NATIONAL CALL CENTER REPRESENTATIVE
Neighborhood Assistance Corporation of America
12.2008 - 10.2009
- Company Overview: (NACA, HUD APPROVED)
- Provided customer service via telephone within a high-volume call center for NACA members throughout the nation
- Assisted Spanish speaking members as a bilingual representative
- Reported recurring problems within the organization regarding escalated issues
- Used specialized database program 'Lynx' to keep records of case files to identify progress
- Trained new staff for the national call center
- Allocated faxed documents through database to corresponding files
- Informed prospective members of services offered through NACA programs
- Scheduled counseling appointments for members to complete a financial package either for the first-time home buyer program or for home save program
- Informed members of solutions and mortgage terminology
- Sustained a personal spreadsheet of all assigned files used to track calls
- (NACA, HUD APPROVED)
Education
BUSINESS MANAGEMENT -
ROXBURY COMMUNITY COLLEGE
BOSTON, MA12.2018
ACCOUNTING CERTIFICATE -
ROXBURY COMMUNITY COLLEGE
BOSTON, MA05.2017
GED -
ADULT LEARNING CENTER
HAMPTON, VA02.2012
MEDICAL ADMINISTRATIVE ASSISTANT CERTIFICATE -
EVEREST INSTITUTE
BRIGHTON, MA08.2008
Skills
- Excellent verbal and written communication
- Billing Software
- Knowledgeable of third party billing software
- Electronic Medical Records
- Ability to multitask and manage time effectively
- Quickbook
- CRM Tool
- Windows
- Microsoft 365 (PowerPoint, Word, Excel, Access)
- Adobe Pro
- Kinnser (ADL)
- Google Work Applications and Drive
- Outstanding problem solving and organizational skills
- Work from Home/Remotely
- HHAeXchange
- Data Entry Specialist
- Healthcare
- Patient confidentiality
- Patient registration
- Insurance verification
- Appointment scheduling
- Patient identity verification
- Fee collection
- Multi-channel communication
- Post-discharge care coordination
- Financial procedures adherence
- Resource allocation
- Medical billing
- Pre-admission requests
- Admitting coordination
- Appointment reminders
- Electronic health records
- Scheduling diagnostic procedures
- Medical coding
- Referral coordination
- Customer follow-up
- Multitasking and organization
- Payment processing
- Medical terminology
- Flexible schedule
- Phone and email etiquette
- Policy understanding
- Statistical data management
- Registration and admissions
- Team collaboration
- Intake assessment
- Verbal and written communication
- Patient education
- Team leadership
- Regulatory compliance
- Relationship building
- Quality assurance
- Call screening
- Training coordination
- Friendly and outgoing
- Health insurance knowledge
- Data entry
- Strong empathy
- Healthcare systems navigation
- Conflict resolution
- HIPAA compliance
- Problem-solving
- Insurance billing
- Complaint processing
- Eligibility determination
- Information collection
- Work quality evaluation
- EMR
- Spanish fluency
- Customer service
- Money handling
- Patient feedback management
- Privacy regulations knowledge
- Cross-cultural sensitivity
- Patient check-in
Timeline
Member/Patient Services Representative
Medix Staffing Solution/Villagecare Max
04.2024 - Current
ASSISTANT PROGRAM MANAGER, FAMILY CAREGIVERS
04.2021 - 10.2023
BILLING COORDINATOR / ADMINISTRATIVE ASSISTANT
Family Caregivers
08.2017 - 03.2021
CUSTOMER RELATIONSHIPS MANAGER
Bank of America / DISYS
06.2011 - 07.2012
LOSS MITIGATION SPECIALIST
Neighborhood Assistance Corporation of America
11.2009 - 05.2011
NATIONAL CALL CENTER REPRESENTATIVE
Neighborhood Assistance Corporation of America
12.2008 - 10.2009
BUSINESS MANAGEMENT -
ROXBURY COMMUNITY COLLEGE
ACCOUNTING CERTIFICATE -
ROXBURY COMMUNITY COLLEGE
GED -
ADULT LEARNING CENTER
MEDICAL ADMINISTRATIVE ASSISTANT CERTIFICATE -
EVEREST INSTITUTE