Anayanzy Melendez

• Serve members by acting as a liaison between the health plan and providers to ensure availability and access to care
• Promote member education, identify and resolve any systemic barriers that limit member’s access to appropriate care
• Work closely with VP of Business Development on multiple projects related to HMO’s, Public Health emergency, and improving processes in partner departments
• Provide knowledgeable and compassionate service in response to patient complaints, questions and concerns
• Help members understand care, coverage, benefits, rights and responsibilities
• Work with members to assist with authorizations, appeals plan decisions and in workflow coordination with providers to resolve problems
• Demonstrates exceptional customer service and conflict resolution skills in addressing dissatisfied members and providers
• Escalates and triages complaints and concerns to appropriate personnel/department(s) as necessary to obtain timely, satisfactory resolution
• Adhere to HIPPA requirements to safeguard patient confidentiality
• Manage high-volume of outbound and inbound member calls
• Review claims, files and other obtained documents to respond to member requests
• De-escalate member problematic concerns, while maintaining calm, friendly demeanor
• Ability to identify and solve problems quickly
• Self-motivated and driven in a remote work environment
• Receive and respond to member complaints to ensure resolution in a timely manner
• Collaborate.
• Developed and maintained courteous and effective working relationships.
• Learned and adapted quickly to new technology and software applications.
• Skilled at working independently and collaboratively in a team environment.
• Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
• Worked well in a team setting, providing support and guidance.
• Goal-oriented professional with proven success in applying analytical skills to solve complex problems and overcome challenges. Dedicated to enhancing team performance and driving business success.
• Passionate about learning and committed to continual improvement.
• Demonstrated strong organizational and time management skills while managing multiple projects.
• Organized professional with expertise in managing resources and optimizing performance. Proficient in providing valuable insights and supporting decision-making processes. Committed to enhancing productivity and contributing to overall success.
• Demonstrated a high level of initiative and creativity while tackling difficult tasks.
• Proven ability to learn quickly and adapt to new situations.
• Paid attention to detail while completing assignments.
• Identified issues, analyzed information and provided solutions to problems.
• Excellent communication skills, both verbal and written.
• Cultivated interpersonal skills by building positive relationships with others.
• Developed strong organizational and communication skills through coursework and volunteer activities.
• Versatile professional with strong problem-solving skills and history of adapting to diverse challenges. Applies innovative solutions and technical expertise to deliver exceptional results. Committed to streamlining processes and advancing organizational objectives.
• Gained strong leadership skills by managing projects from start to finish.
• Applied effective time management techniques to meet tight deadlines.

• Assist patients with continuous care by identifying their past and current medical needs
• Contact patients to assist with their healthcare needs by providing information, scheduling appointments, pending orders, and referrals and closing and gap due
• Review patient’s medical chart to help identify Diabetes, past due adult, and child preventative health screenings
• Communicate with physician and clinical staff of patient medical needs
• Assist patients by educating them of the medical importance of fulfilling their preventative health screenings
• Project management presentations and virtual communication
• Participate in department meetings and quality improvement meetings
• Assist with Department projects and improvement of projects
• Participate in peer interviews for new employees
• Site huddle leader rep for department
• Train, and mentor new hires on department workflow, customer service and metrics requirements
• Assist new and existing employees with current, and new workflow needs when instructed by supervisor
• Assist with all department projects and workflow improvement.

• Offer financial advice and assistance to patients by working with their insurance companies to coordinate payments and answer questions from both parties
• Educate patients about payment options and financial assistance
• Work in partnership with the hospital as a liaison to provide patients with cost estimates prior to admission and to advise patients on paying for services
• Verify and assure all accounts are ready for billing with adequate supporting documentation, within the required time frame
• Educate patients about payment options and financial assistance
• Appropriately and accurately document and report payment information; review and process patient and insurance company forms; update patient accounts and balances
• Bedside collections and update all inpatient, outpatient, and surgery accounts to ensure completeness and accuracy
• Provide estimates for procedures to patient’s, physician’s offices and payers as requested
• Surgical procedures and Radiology check-in; ED check-in
• Manage workload and projects assigned by management to meet operations expectations
• Assist with escalation requests for system and Revenue cycle policies such as, financial assistance, Point of service, out of network, outpatient valid orders
• Monitors financial performance of the department by ensuring financial conversations and attempts to collect are made and assists Access services leadership with flexing staff to volumes
• Serves as a role model for staff in maintaining effective communication with internal and external customers, including employees, patients, guests, insurance companies, hospital, and hospital personnel.

• Work in partnership with the hospital to target specific high need patients, particularly those without a primary care provider
• Work directly with the Program Director on development and implementation of strategies in improving the program's policies and goals
• Provides informal counseling, education, and social support to clients
• Assists clients with utilizing available resources, including scheduling medical appointments, accompanying clients to appointments, and assisting with completion of medical program applications
• Develops and maintains strong working relationships with external referral sources and community agencies) and internal contacts
• Maintains accurate client records by documenting all contacts, services provided and outcomes to track all clients and services for future reference
• Contact patients in person, or by phone to ensure they have completed required or recommended actions upon discharge
• Determines possible eligibility for charity assistance, and charity policy
• Cultivate and maintain internal and external relationships and serve as a liaison between departments.

• Responsible for ensuring seamless care for patients by acting as liaison between patients and the Center
• Work closely with program director to develop and implement new growth strategies to increase sales to meet program goals
• Primary point of contact to vendor partners to meet the needs of the program
• Facilitate the patient’s initial contact with the Center by scheduling new and follow up patient visits via telephone and email
• Assisted with travel and hotel accommodations occasionally when necessary
• Follow up with patients to ensure appropriate care and required next steps are being facilitated
• Have strong knowledge of each clinic and surgeon and effectively sell services to all callers
• Ensure patients are scheduled with the appropriate physician or clinic
• Input all referrals into the appropriate system in accordance with program guidelines
• Assisted clinics to help with patients who have not scheduled follow-up visits and discover why to aid them back in the program
• Assisted program director with sales related activities
• Assisted program director with monthly and quarterly reports
• Assisted in the training and supervision of new employees
• Maintain and promote HIPPA compliance in all areas
• Extensive knowledge of insurance concepts
• Exceptional customer service, problem solving, and analytical skills, documentation
• Cultivate and maintain internal and external relationships and serve as a liaison between departments
• Assist with educating and training providers and their office staff on the process work of the program and respond to all concerns.

• Front desk management, Check In/Check Out of patients, scheduling, appointments, maintaining the timely flow of patients
• Insurance verification and authorization, pre-certification, and update system with new and updated benefits
• Acquired and processed patient’s demographics and insurance information
• Reviewed and informed patients of financial arrangements and/or medical benefits; deductibles, copay, and balance collections
• Prepared letters for referring physicians
• Effective communicator with ability to multitask in a high-volume office work environment
• Highly proficient in providing translation in Spanish, both written and verbal
• Responsible for maintaining business office inventory and ordering supplies
• Performed other duties as assigned.

• Assist manager with process improvement (office workflow from patient point of view)
• Provide assistance and comfort to patients’ families as necessary
• Perform other duties assigned by Director or Manager
• Responsible for communicating deficiencies at the front desk to front desk manager
• Assists patient and family members in arranging local lodging and leisure accommodations
• Keep spreadsheet of all patient feedback (Excel) in efforts to identify areas of best practice, areas requiring immediate attention and/or improvement
• Assist patients and families during transition to in-patient or other surgical floors

Assist patients with the explanation of benefits, deductibles, copays, and coinsurance due at time of service.

• Worked well in a team setting, providing support and guidance.
• Organized professional with expertise in managing resources and optimizing performance. Proficient in providing valuable insights and supporting decision-making processes. Committed to enhancing productivity and contributing to overall success.
• Developed strong organizational and communication skills through coursework and volunteer activities.
• Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
• Skilled at working independently and collaboratively in a team environment.
• Identified issues, analyzed information and provided solutions to problems.
• Gained strong leadership skills by managing projects from start to finish.
• Goal-oriented professional with proven success in applying analytical skills to solve complex problems and overcome challenges. Dedicated to enhancing team performance and driving business success.
• Paid attention to detail while completing assignments.
• Developed and maintained courteous and effective working relationships.
• Versatile professional with strong problem-solving skills and history of adapting to diverse challenges. Applies innovative solutions and technical expertise to deliver exceptional results. Committed to streamlining processes and advancing organizational objectives.
• Learned and adapted quickly to new technology and software applications.
• Demonstrated a high level of initiative and creativity while tackling difficult tasks.
• Proven ability to learn quickly and adapt to new situations.
• Passionate about learning and committed to continual improvement.
• Excellent communication skills, both verbal and written.
• Cultivated interpersonal skills by building positive relationships with others.
• Applied effective time management techniques to meet tight deadlines.
• Demonstrated strong organizational and time management skills while managing multiple projects.

• Evaluated, fitted, and provided orthopedic braces to patients and implemented plan/programs to improve patient quality of life
• Instructed and educated patient in the use and care of the orthopedic device
• Maintained patient records
• Conferred with physicians to formulate specifications and prescriptions for orthopedic devices
• Engaged in constant communication with the patients to be provided with an assurance that they are well-informed with their condition
• Cultivate and maintain internal and external relationships and serve as a liaison between departments and physicians.