Claudia Garcia
Edinburg,TX
Summary
Dynamic Provider Services Representative with a proven track record at Nuestra Esperanza Health Care, excelling in claims resolution and enhancing provider relations. Leveraging strong customer service and attention to detail, I effectively improved communication between providers and insurance companies, driving operational efficiency and fostering a collaborative environment.
Healthcare professional with comprehensive experience in provider services. Adept at managing provider relations and facilitating seamless communication within healthcare networks. Renowned for fostering team collaboration and adapting to evolving operational needs, along with strong conflict resolution and organizational skills that employers value.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Provider Services Representative
Nuestra Esperanza Healt Care
04.2013 - 11.2023
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
- Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
- Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
- Acted as a liaison between providers and company leadership, effectively communicating concerns and feedback to facilitate continuous improvement initiatives.
- Improved communication between providers and insurance companies, leading to better understanding of policy coverage and claim status.
CNA
Apex Primary Care
03.2009 - 04.2013
- Assisted patients with daily living activities, promoting independence and dignity.
- Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
- Promoted good oral and personal hygiene by aiding patients with shaving, bathing, and teeth brushing.
- Enhanced patient satisfaction by providing compassionate and attentive care.
- Maintained confidentiality of patient information according to HIPAA guidelines while communicating effectively with team members about critical updates.
- Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
- Utilized proper body mechanics and assistance devices when transferring patients, minimizing the risk of injury for both parties.
- Ensured prompt response to call lights, addressing patient needs in a timely manner.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
- Prevented bedsores by regularly repositioning patients and implementing proper wound care techniques.
- Delivered individualized patient care by recording vital signs, documenting observations, administering treatments, and evaluating patient needs.
- Provided emotional support for patients during challenging times, fostering a positive healing environment.
- Implemented fall prevention measures by identifying high-risk patients and maintaining clutter-free environments around bedsides.
- Cared for residents in assisted living facility and delivered high-quality support to meet needs.
- Reduced patient stress levels through effective communication and active listening skills.
- Promoted infection control practices within the facility by adhering to strict hand hygiene procedures and utilizing personal protective equipment when necessary.
- Cared for clients with diagnoses such as respiratory failure, diabetes, Parkinson's disease and muscular dystrophy.
- Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
- Evaluated patients to identify and address wounds, behavioral concerns, and medically relevant symptoms.
- Oversaw and maintained patients' rooms, group living areas, and nurse stations.
- Assisted in emergency situations under the direction of nursing supervisors or physicians, providing crucial support during life-saving interventions.
- Supported ambulation and physical therapy needs by conducting planned exercise routines.
- Conducted routine safety checks on equipment, promptly reporting any malfunctions or safety concerns to appropriate personnel.
Education
High School Diploma -
COLLEGIO DOCTOR FRANCISCO G GONZALEZ
Mexico, ME06-1990
Skills
- Claims resolution
- Customer service
- Data entry
- Policy interpretation
- Attention to detail
- Adaptability
- HIPAA compliance
- Operational efficiency
- Healthcare industry
- Provider relations
- Teamwork and collaboration
Accomplishments
i was recognized in home health as a really good provider and the employee of the month. In DHR i have been recognized as a no call in employee of the time i have been there .
Certification
High school diploma
Counter diploma
Languages
Spanish
Full Professional
English
Elementary
Timeline
Provider Services Representative
Nuestra Esperanza Healt Care
04.2013 - 11.2023
CNA
Apex Primary Care
03.2009 - 04.2013
High School Diploma -
COLLEGIO DOCTOR FRANCISCO G GONZALEZ
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