Daisy Montoya
Houston,TX
Summary
Compassionate Patient Services Coordinator equipped with top-notch administrative, billing and customer service skills. Manages appointments and scheduling with organized approach. Proficient in coordinating insurance authorizations and maintaining medical records and well-versed in performing diverse administrative functions for patient care with high degree of diplomacy and problem-solving acumen. In addition, Positive and upbeat team player with good communication and time management abilities. Demonstrates extreme attention to detail with accuracy as team lead.
Overview
14
14
years of professional experience
Work History
Sr. Patient Service Representative
Houston Methodist- Primary Care Group
Houston , TX
2021.02 - Current
- Verified demographics and insurance information to register patients in the computer system
- Applied knowledge of payer requirements and utilized online eligibility systems to verify patient coverage and policy limitations.
- Communicated financial obligations to patients and collected fees at time of service.
- Referred unresolved customer grievances to designated departments for further investigation.
- Increased customer satisfaction ratings 95% by effectively answering questions, suggesting effective solutions and resolving issues quickly.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Applied HIPAA privacy and security regulations while handling patient information.
- Checked stock to determine inventory level and placed orders for needed supplies.
- Resolved customer inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks.
- Offered resolutions to de-escalate calls and solve patient issues.
- Collaborated with clinical and administrative staff to meet patient needs.
- Verified documentation methodically to avoid critical errors impacting care delivery and payments for services.
- Cultivated positive relationships with patients to help facility meet satisfaction scores and patients obtain best possible care.
- Scheduled lunch meetings to gather staff with Pharmaceutical, Home Health, and Medication Sales Representatives.
- Trained new facility staff.
- Assessed need for additional staff, equipment and services based on historical data and seasonal trends.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every patient.
Insurance Verification Specialist
Houston Methodist Hospital
Houston , TX
2017.04 - 2019.05
- Verified benefits for diagnostic imaging outpatient, inpatient and outpatient surgeries.
- Submitted pre-authorizations for required exams
- Contacted patients with estimated cost of exam for the date of service
- Cancelled or rescheduled appointments for patients if necessary,
- Worked with online diagnostic authorization portals such as AIM and Evicore
- Worked within Epic system software for the labor and delivery unit
- Pre-register patients to obtain estimated costs for hospital stay
- Direct admit obstetric patients, Register obstetric patients for outpatient pre-op labs
- Collected payments
- Worked within various Epic functionalities
- Checked documentation for appropriate coding, catching errors and making revisions.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Entered data in EMR database to record payer, authorization requirements and coverage limitations.
- Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
Patient Access Representative
Texas Children's Hospital
Houston , TX
2015.09 - 2017.04
- Worked and mastered Epic system templates for outpatient diagnostic imaging, emergency room, and urology department.
- Obtained authorizations from commercial and government insurance for outpatient procedures
- Collect co-pays, insurance deductibles, and/ or coinsurance
- Gather patient/parent demographics and correctly create a patients account or update existing patient accounts with updated demographics including insurance
- Assist with payment plans, scheduling appointments, and assist MRI, IR, CT, US techs/nurses with proper patient information/status
- Assist with diagnosis codes for outpatient and urology services
- Input urology referrals for specialty services from doctors offices.
Patient Access Representative
Memorial Hermann
Houston , TX
2014.06 - 2015.09
- Register patients in the ER
- Obtain correct demographic information, assist with translation (Spanish), inform triage nurses about patients to be triaged and/or waiting to be taken to a room
- Inform triage nurses about EMS arrival
- Verify patient insurance and collect co-pays.
Patient Access Coordinator
St. Anthony's Hospital
Houston , TX
2010.06 - 2014.06
- Obtained demographics/ registered into hospital system for ER patients, surgery patients, outpatients, and inpatients
- Verified medical insurance, obtained prior authorizations for procedures, inputted outpatient and inpatient orders for medical staff.
- Assisted triage nurses/doctors with translation between patients
- Collect all required documents from all patients, assist with PAR hiring, coordinate PAR's monthly schedule, input OR charges for billing, contact third-party payers to obtain proper billing information and/or required authorizations for workers' compensation.
- Contact all contracted payers/insurance for proper hospital reimbursement.
- Corrected and resubmitted denied claims.
- Directed, supervised and evaluated medical, clerical or maintenance personnel.
- Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Recruited, hired and trained new medical and facility staff.
- Established solid relations with leadership and staff by attending board meetings and coordinating interdepartmental information exchanges.
- Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
Education
Diploma -
W.T. Hall Center for Education
Houston, TX01.2008
Skills
- Bilingual (Spanish)
- EPIC
- Insurance Authorization
- Payment Processing
- CPT Coding
- Workers Compensation
- Revenue Cycle Management
- Managed Care (HMO, PPO, POS)
- Claim Processing
- HIPAA Compliance
- Diagnostic Imaging
- Emergency Room
- Primary Care
- Surgical Pre Authorizations
- Registration and Admissions
- HIPAA Compliance
- Registration management
- Quality Assurance
- Scheduling
- Financial Procedures Adherence
- Training Coordination
- Phone and Email Etiquette
- Team Collaboration
- Referral Coordination
- Team Leadership
- Eligibility Determination
Additional Information
I am knowledgeable with medical terminology, medical insurance billing process, and Epic System. I have worked for various departments such as Urology, Diagnostic Imaging, Inpatient and Outpatient Surgeries, Primary care, Emergency Room, Labor & Delivery, and Insurance Verification.
Assessments
- Customer Focus & Orientation, Highly Proficient, 10/01/19
- Medical Billing, Highly Proficient, 11/01/19
- Insurance Verifier for Medical Office (In-house), Proficient, 11/01/19
- Customer Focus & Orientation, Highly Proficient, 12/01/19
- Medical Receptionist Skills, Highly Proficient, 01/01/20
Timeline
Sr. Patient Service Representative
Houston Methodist- Primary Care Group
2021.02 - Current
Insurance Verification Specialist
Houston Methodist Hospital
2017.04 - 2019.05
Patient Access Representative
Texas Children's Hospital
2015.09 - 2017.04
Patient Access Representative
Memorial Hermann
2014.06 - 2015.09
Patient Access Coordinator
St. Anthony's Hospital
2010.06 - 2014.06
Diploma -
W.T. Hall Center for Education
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