Brianda Martinez
CHI Health Clinic
Dalton
1
Certification
7
years of professional experience
Experienced with insurance claim follow-up and resolving discrepancies. Utilizes strong analytical skills to manage and track claim statuses. Knowledge of healthcare regulations and effective communication techniques to ensure accurate and timely resolutions.
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Collaborative leader partners with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires and providing customized solutions to build loyalty.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Work History
Insurance Follow-Up Specialist
8 Months- Coordinated follow-up on insurance claims to ensure swift resolution of pending balances and enhance customer satisfaction.
- Engaged with healthcare providers to confirm patient insurance eligibility and clarify coverage specifics, enhancing patient care processes.
- I was always one of the tops on production.
- Investigated patterns in claim denials to optimize submission processes and minimize future discrepancies.
- Resolved complex patient inquiries related to billing issues and insurance processes.
- Analyzed claim denials and identified trends to improve future submissions and reduce errors.
- Handled complex inquiries from patients regarding billing issues and insurance processes.
- Trained new team members on best practices for claims processing and follow-up procedures.
- Developed standardized processes that enhanced workflow efficiency in claims management.
- Coordinated cross-departmental communication to resolve discrepancies related to patient accounts.
- Led initiatives to streamline billing operations, resulting in improved claim turnaround times.
- Developed strong relationships with payer representatives, facilitating faster issue resolution for unpaid claims.
- Managed multiple priorities effectively while working within tight deadlines, ensuring optimal outcomes for both clients and the organization as a whole.
- Maintained thorough documentation of all follow-up activities, ensuring proper tracking and reporting of account status.
- Collaborated with insurance companies to expedite claim processing, improving cash flow management.
- Boosted revenue recovery by identifying and resolving errors in billing and coding practices.
- Participated in regular staff meetings to discuss and strategize action plans for problematic accounts, resulting in improved collections performance.
- Supported team members in resolving complex issues, fostering a collaborative work environment focused on continuous improvement.
- Resolved patient disputes promptly regarding insurance coverage or billing matters.
- Provided exceptional customer support to patients and insurance companies, fostering positive relationships and maintaining a high level of client satisfaction.
- Contributed to team success by meeting or exceeding monthly collection goals while maintaining high standards of accuracy and professionalism.
- Monitored aged account receivables closely to identify trends affecting payment cycles.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Maintained up-to-date knowledge of product and service changes.
- Responded proactively and positively to rapid change.
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
Insurance Follow-Up Representative
3 Years 11 Months- Executed insurance claim processing to ensure timely reimbursement and support operational efficiency in a fast-paced healthcare environment.
- I was always being recognized for meeting production and meeting goals at the end of the quarter.
- Conducted thorough investigations into insurance claim denials and discrepancies, implementing corrective actions as necessary.
- Managed follow-up on unpaid claims, collaborating with insurance companies to secure payments.
- Utilized in-depth understanding of medical coding and insurance guidelines to enhance accuracy in claims submissions.
- Developed comprehensive reports and gathered data to optimize workflows and increase productivity.
- Monitored and analyzed third-party payers' policies and regulations to ensure compliance.
- Managed patient inquiries, ensuring prompt and precise responses to support care delivery.
- Managed status updates and tracking processes for insurance claims and payments to ensure timely resolution.
- Coordinated efforts with billing department to ensure timely and efficient collection of payments.
- Established and maintained strong client connections to enhance trust and satisfaction through reliable service.
- Ensured accuracy in documenting customer interactions and transactions to enhance service quality.
- Handled customer inquiries and effectively managed complaint resolution to maintain positive client relationships.
- Ensured adherence to insurance policies and procedures to enhance operational efficiency.
- Oversaw customer feedback analysis and escalated issues to management.
- Delivered outstanding professionalism and customer service in all interactions with clients.
- Coordinated communication with insurance providers to verify coverage and payment status.
- Managed claims follow-up processes to ensure timely resolution of outstanding accounts.
- Developed training materials for new staff on insurance verification protocols and systems.
- Increased efficiency in resolving complex cases by maintaining strong relationships with insurance providers, facilitating clear communication and prompt issue resolution.
- Contributed to a positive work environment by sharing best practices among peers and actively participating in team meetings geared towards continuous improvement.
- Safeguarded patient privacy by adhering to HIPAA guidelines when handling sensitive personal information during claim follow-up processes.
- Reduced errors in claim submissions by conducting thorough audits of patient accounts prior to submission, ensuring accuracy and completeness of information.
- Responded proactively and positively to rapid change.
Insurance Representative
1 Year 3 Months- Developed and implemented strategies to ensure maximum reimbursement for services rendered
- Managed multiple client accounts, ensuring accuracy and timeliness of medical insurance claims
- Researched and resolved complex billing issues to ensure accuracy of payment
- Developed and maintained relationships with insurance providers to ensure prompt payment
- Communicated with customers to answer questions regarding medical insurance coverage
- Assisted customers in selecting the most appropriate medical insurance plan
- Processed and tracked medical insurance applications
- Followed up on denials and appeals for medical insurance claims
- Analyzed medical insurance policy documents and claims to evaluate coverage
- Generated reports to identify trends and discrepancies in medical insurance claims
- Analyzed insurance claims for compliance with company policies and industry regulations.
- Verified patient insurance coverage to ensure compliance with healthcare regulations.
- Processed authorization requests efficiently, reducing delays in patient care.
- Collaborated with healthcare providers to resolve discrepancies in insurance information.
- Analyzed trends in claim denials to develop strategies for reducing future occurrences.
- Collaborated with healthcare providers to ensure accurate billing codes for various procedures.
- Reduced claim denials by thoroughly reviewing patient eligibility and coverage details.
- Maintained up-to-date knowledge of insurance policies, regulations, and industry trends to provide accurate information to clients.
- Achieved faster claim processing times through diligent follow-up on pending authorizations and referrals.
- Contributed to company growth by consistently meeting performance metrics for speed, accuracy, and client satisfaction in the insurance verification process.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Updated patient records with accurate, current insurance policy information.
- Performed various administrative tasks by filing, copying and faxing documents.
- Processed medical insurance claims and payments.
- Assisted with medical coding and billing tasks.
Receptionist
1 Year 3 Months- Led the guest reception process, enhancing visitor experience through direct engagement and strategic inquiry management. Oversaw guest interactions, streamlining communication channels for efficient inquiry resolution. Transformed visitor experience by optimizing greeting strategies and guiding inquiry processes.
- Oversaw reception area operations, including management of reception desk and lobby environment.
- Oversaw appointment scheduling and management, ensuring efficient use of company calendar.
- Managed over 50 patient calls per day.
- Oversaw office supplies inventory management and coordinated timely procurement of necessary items.
- Managed office supply inventory to optimize availability and streamline ordering processes.
- Monitored and controlled access to the building while upholding safety standards to protect office premises.
- Organized and retrieved documents and records effectively. Supported the maintenance of filing systems.
- Managed operation of office equipment, including fax machines, copiers, and telephone systems.
- Coordinated receipt and dispatch of mail and packages, maintaining organized tracking systems.
- Collaborated on special projects, ensuring alignment with organizational goals and objectives.
- Managed front desk operations, ensuring smooth visitor check-in and appointment scheduling.
- Coordinated communication between departments, enhancing information flow and responsiveness.
- Trained new staff on front desk protocols and customer service best practices.
- Implemented efficient filing systems to improve document retrieval processes.
- Led initiatives to enhance front desk efficiency, resulting in reduced wait times for clients.
- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Maintained organized and clean front office area to create professional and welcoming environment for visitors and employees.
- Scheduled, coordinated and confirmed appointments and meetings.
- Managed high-volume phone calls, directing inquiries to appropriate personnel for prompt resolution.
- Collected room deposits, fees, and payments.
- Handled sensitive customer information with confidentiality, adhering to company privacy guidelines.
- Developed strong working relationships with team members, fostering a positive work environment.
- Resolved customer issues quickly and notified supervisor immediately when problems escalated.
Education
Associate of Applied Science - Business Healthcare Technology AAS
Healthcare Billing And Coding Specialist - Medical Coder
Skills
Attention to detail
Bilingual
Problem-solving skills
Adaptability to change
Effective communication
Collaborative teamwork
Strong organizational skills
Team leadership
Effective time management
Critical thinking capacity
Computer software proficiency
Conflict resolution
Multitasking
Computer skills
Relationship building
Professionalism
Certification
- Coding: What You Need to Know for Optimal Payment
- Reimbursement: New Payment Models
- Medicare Billing: Form CMS-1450 and the 837 Institutional
- 2022 Medicare Part C and Part D Reporting Requirements and Data Validation
- Negotiating and Getting Paid by Insurers
- Medicare Billing: Form CMS-1500 and the 837 Professional
Languages
Spanish
Timeline
Insurance Follow-Up Specialist
CHI Health Clinic
2024.09 - 2025.05Read More
Insurance Follow-Up Representative
CHI Memorial
2020.10 - 2024.09Read More
Insurance Representative
Hamilton Medical Center
2019.06 - 2020.09Read More
Receptionist
Aspire Dental
2018.03 - 2019.06Read More
Georgia Northwestern Technical College
Associate of Applied Science from Business Healthcare Technology AAS
Read More
Georgia Northwestern Technical College
Healthcare Billing And Coding Specialist from Medical Coder
Read More