Summary
Overview
Work History
Education
Skills
Timeline
Generic

Diana Hayes

Montgomery,Tx

Summary

Professional with extensive experience in customer service, intake processing, and patient care coordination. Proven ability to handle multiple tasks effectively and efficiently in a fast-paced environment. Demonstrates strong teamwork, problem-solving, and time-management skills. Prepared to start a career and make meaningful contributions, with commitment and drive.

Overview

7
7
years of professional experience

Work History

CSR Consultant

Salem Solutions- Trinet
Remote
01.2025 - 07.2025
  • Calls daily from members and provider inquiries, requests, and concerns for authorization and claims questions.
  • Verified patient information and providers' credentials for compliance with insurance requirements.
  • Documented all members, provider information, and communication for quality performance tracking through CRM systems.
  • Resolved basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if the calls needed to be routed to another department for further resolution.
  • Maintained and adhered to all HIPAA rules and regulations.

Referral and Authorizations Specialists

Salem solutions- HealthNet
Remote
01.2024 - 01.2025
  • Validated patients and medical providers' demographic information with the correct selection of provider specialty for healthcare services.
  • Determined patient eligibility to receive healthcare benefits under the insurance program by determining the patient status and eligibility for PCM type, and with the appropriate referral and authorization needed for the specialty.
  • Contacted medical provider offices for verification purposes of CPT codes or referral status.
  • Updated patient information, call notes, and any documents in the CRM system.
  • Adhered to HIPAA rules and regulations.

Accountants Receivable Specialist

Sonic Healthcare
Austin, Tx
02.2018 - 12.2023
  • Responsible for managing and collecting the outstanding balance owed by health insurance payors through follow-up calls and submission of appeals via paper claims or electronically.
  • Monitored accounts to verify compliance with payment terms and schedule.
  • Reviewed accounts monthly to assess aging, and pursued the collection of funds.
  • Utilized Microsoft Excel software to manage invoices and payments.
  • Implemented all policies and procedures to ensure compliance with internal and external regulations. Maintained HIPAA rules and regulations.

Education

High School -

ANDERSON HIGH SCHOOL
Austin, TX
06-1995

Skills

  • Insurance verification
  • Data entry accuracy
  • Customer service
  • Medical terminology
  • Navinet
  • Care radius
  • Salesforce
  • aws
  • Opsconnect
  • RADS tool
  • Fusion/Mysis fin
  • Sceris
  • MTF ASSIST
  • Does (Defense Online Enrollment System)
  • Claims processing
  • CRM management
  • Patient verification
  • Referral coordination
  • HIPAA compliance

Timeline

CSR Consultant

Salem Solutions- Trinet
01.2025 - 07.2025

Referral and Authorizations Specialists

Salem solutions- HealthNet
01.2024 - 01.2025

Accountants Receivable Specialist

Sonic Healthcare
02.2018 - 12.2023

High School -

ANDERSON HIGH SCHOOL

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Diana Hayes