Summary
Overview
Work History
Skills
Work Preference
Timeline
Generic

Anayanzy Melendez

Account Executive
San Marcos,TX

Summary

Extensive experience offering support and mentoring to team members to engage and retain clients in service Extensive knowledge of insurance concepts. Bi-lingual and highly proficient in the Spanish language (speaking, writing, reading) Proficient in the use of Microsoft applications and general office equipment Strong organizational skills, ability to prioritize and multitask, accurate, efficient, and dependable Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Ambulatory setting, Medical Terminology, ICD-10 and CPT codes, Medicare and/or Medicaid Services Excellent verbal and written communication skills Strong ability to engage with others, listen and adapt response to meet others’ needs Prioritize participation in quality improvement projects, meetings, and training Exceptional customer service experience making outbound calls

Overview

15
15
years of professional experience

Work History

Account Executive

Dell Children’s Health Plan
Austin, TX
08.2022 - Current
  • 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, whilemaintaining 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

Health Coordinator

Baylor Scott & White- Quality Alliance
Round Rock, TX
10.2021 - 08.2022
  • 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

Financial Counselor

Baylor Scott & White
Austin, TX
10.2019 - 10.2020
  • 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.

Patient Navigator

Ascension Dell Seton Medical Center
12.2018 - 04.2019
  • 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.

Patient Navigator

Texas Health Center for Diagnostics, Surgery
08.2016 - 07.2018
  • 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

Patient Liaison

Advanced Dermasurgery Associates
04.2013 - 04.2016
  • 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

Referral Coordinator

First Choice OB/GYN
El Paso , TX
05.2011 - 08.2011
  • Telephone and front desk
  • Check in and check out
  • Insurance verification and pre-certification
  • Processed patient’s demographics
  • Responsible for most customer service inquiries
  • Assist patients with the explanation of benefits, deductibles, copays, and coinsurance due at time of service
  • Skilled at working independently and collaboratively in a team environment.
  • Organized and detail-oriented with a strong work ethic.
  • Passionate about learning and committed to continual improvement.
  • Worked flexible hours across night, weekend, and holiday shifts.
  • Learned and adapted quickly to new technology and software applications.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Assisted with day-to-day operations, working efficiently and productively with all team members.
  • Worked effectively in fast-paced environments.
  • Worked well in a team setting, providing support and guidance.
  • Paid attention to detail while completing assignments.
  • Proven ability to learn quickly and adapt to new situations.
  • Managed time efficiently in order to complete all tasks within deadlines.
  • Proved successful working within tight deadlines and a fast-paced environment.
  • Self-motivated, with a strong sense of personal responsibility.
  • Demonstrated strong organizational and time management skills while managing multiple projects.

Sales Representative

Precision Prosthetics
11.2009 - 05.2011
  • 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

Skills

  • Account Management
  • Client Relationship Building
  • Relationship building and management
  • Written and verbal communication
  • Customer Service
  • New business opportunities
  • CRM software expertise
  • Customer Relations
  • Territory Management
  • Customer Relationship Management (CRM)
  • Business development and planning
  • Customer Relationships
  • Customer Presentations
  • Lead Development
  • Customer rapport
  • Sales Strategies
  • Lead Generation
  • Strong relationships
  • Interpersonal Skills
  • Account planning
  • Performance Tracking
  • Sales proficiency
  • Goals and performance
  • Contract Negotiation
  • Sales expertise
  • Research and analysis
  • Account Servicing
  • Business Development
  • Staff Management
  • Data Analysis
  • Account oversight
  • Revenue Generation
  • Account Management
  • Vendor Management
  • Strategic Initiatives
  • Market development
  • Database Management
  • Marketing strategy implementation
  • Sales target monitoring
  • Marketing Management
  • Progress Reporting
  • Financial Reporting
  • Service Coordination
  • Systems and software expertise
  • Operations
  • Order Management
  • Budget Development
  • Forecast preparation
  • Service Management
  • Time Management
  • Attention to Detail
  • Teamwork and Collaboration
  • Organizational Skills
  • Multitasking
  • Problem-Solving
  • Active Listening
  • Multitasking Abilities
  • Excellent Communication
  • Task Prioritization
  • Decision-Making
  • Team building
  • Conflict Resolution
  • Cash Handling
  • Written Communication
  • Account Management
  • Processing payments
  • Stock management
  • Point of sale operation
  • Analytical Thinking
  • Interpersonal Communication
  • Problem-solving abilities
  • Reliability
  • Customer Satisfaction
  • Team Collaboration
  • Team Leadership
  • Effective Communication
  • Adaptability and Flexibility
  • Self Motivation
  • Goal Setting
  • Professionalism
  • Strategic Planning
  • Solution selling
  • Sales strategy
  • Time management abilities
  • Continuous Improvement

Work Preference

Work Type

Full Time

Work Location

RemoteHybrid

Important To Me

Career advancementCompany CultureWork-life balanceHealthcare benefitsWork from home optionPaid time offPaid sick leave401k match4-day work week

Timeline

Account Executive

Dell Children’s Health Plan
08.2022 - Current

Health Coordinator

Baylor Scott & White- Quality Alliance
10.2021 - 08.2022

Financial Counselor

Baylor Scott & White
10.2019 - 10.2020

Patient Navigator

Ascension Dell Seton Medical Center
12.2018 - 04.2019

Patient Navigator

Texas Health Center for Diagnostics, Surgery
08.2016 - 07.2018

Patient Liaison

Advanced Dermasurgery Associates
04.2013 - 04.2016

Referral Coordinator

First Choice OB/GYN
05.2011 - 08.2011

Sales Representative

Precision Prosthetics
11.2009 - 05.2011

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Anayanzy MelendezAccount Executive