Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Edna Lopez

Baytown,TX

Summary

Highly skilled and enthusiastic professional with more than 15 years of experience in the healthcare industry.

Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Overview

20
20
years of professional experience

Work History

MEDICARE ADVANTAGE TELESALES AGENT

TTEC
08.2023 - 12.2023
  • Built relationships with customers using strong persuasion and active listening skills.
  • Answered questions about company offerings with knowledgeable responses about products and services.
  • Answered calls, took messages, and transferred calls to correct individuals.
  • Delivered scripted sales pitch to potential customers, adjusting pitch to meet needs of specific individuals and businesses.
  • Called prospective customers in designated market area to qualify leads.
  • Asked pertinent questions to understand customer requirements.
  • Educated customers on product and service benefits, explaining features and answering questions.
  • Set up appointments with interested customers according to schedule availability.

Realtor Sales Associate

EXp Realty, LLC
01.2019 - Current
  • Advised and informed prospective clients on current market activities and conditions.
  • Compared recently sold area properties to determine competitive market prices.
  • Assisted buyers with finding ideal homes by assessing needs, requirements and budgets.
  • Wrote contracts to outline sales and purchases of properties.
  • Interviewed clients and generated lists of potential properties meeting specific requirements from available listings.
  • Completed property walkthroughs before completing deals to uphold accuracy in listings and appraisals.
  • Verified payment and loan paperwork for property sales by working closely with banks, buyers and sellers.
  • Prepared homes for client arrivals during open house events and established signage and wayfinding aids.
  • Advised sellers on ways to increase curb appeal and make homes more appealing to potential buyers.
  • Reviewed and executed confidential documents, contracts and disclosures.
  • Coordinated appointments to show tenants and buyers prospective homes.
  • Negotiated contracts with buyers and sellers to maximize customer savings.
  • Performed home evaluations and developed competitive market analysis for individual homes.
  • Followed-up escrow process, coordinated contingency removal of property inspection and maintained timely closing of escrow.
  • Worked closely with clients to facilitate appropriate loans, inspections and credit reports.

Billing and Credentialing Clerk

PARS MRI
05.2015 - 03.2018
  • Audited all patient billing files. Cross checked for accuracy of clean claims for electronic transmission. Filed paper claims when applicable.
  • Cross checked for appropriate \ pre-authorization, diagnosis codes, and date range when applicable
  • Worked A/R reports
  • Worked collections, disputes, appeals, and pulled medical records for medical necessity
  • Credentialed providers and the facility with insurance carriers
  • Prepared patient statements and handled all billing questions
  • Served as resource for physicians in credentialing and privileging process.
  • Maintained strict confidentiality with regard to protected health information.
  • Obtained NPI numbers for providers when onboarding

Medical Staff Office Coordinator

Bayshore Medical Center / East Houston Regional
07.2014 - 09.2014
  • Prepared all physician files for credentialing or re-credentialing
  • Attended all committee meetings and followed up with physician’s staff for current documents
  • Took minutes at meetings and had video conferences with both HCA campuses.
  • Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.

Operations, Member representative

MCO / Community Health Choice
05.2014 - 07.2014
  • Medicaid & CHIP, MCO)
  • Trained in all benefits for plans for members enrolled with Community
  • Worked the call center and provided customer service for every member calling in
  • Provided all tools and information that members needed after carefully screening all calls before releasing any PHI
  • Educated members on benefits they did not know were offered by being a Community member.

Billing and Credentialing Coordinator

Bay Area Rehabilitation Center
02.2008 - 04.2013
  • Reviewed all super bills for correct services and diagnosis to prepare for billing
  • Transmitted electronic billing through our clearing house and also mailed CMS 1500 if needed to carriers that needed a paper bill
  • Entered all charges and also entered all payments from insurance carriers and patients to corresponding accounts and DOS
  • Reconciled all receivables at the end of each day and month to ensure proper posting and balancing
  • Credentialed all new staff and re-credentialed all current staff through CAQH to add to various insurance carriers as participating providers
  • Coordinated with scheduling to quote patients as per fee schedule
  • Worked collections, disputes, appeals, and reconsiderations
  • Also mailed all bills to workers compensation with corresponding medical records
  • Attended safety meetings as representative of the administration department
  • Ordered office supplies for the administration building
  • Made deposits and reviewed our bank account against our excel sheet when CEO was out.
  • Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
  • Worked closely with practitioners to help each obtain privileges at assigned healthcare facilities
  • Enrolled providers and Medicaid, Medicare and private insurance plans.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Prepared records for site visits and file audits.
  • Improved office efficiency by effectively managing internal communications and correspondence.

Registration, Insurance Verification Clerk

The Methodist Hospital San Jacinto
08.2005 - 03.2007
  • Compiled the most current demographic and insurance information from all patients
  • Photo copied all needed identification cards and insurance cards
  • Registered in a timely manner for minimal patient wait time
  • Collected copays at time of registration
  • Verified eligibility and benefits
  • Screened new OB patients to determine if they were high risk and required being referred to appropriate facility and physician
  • Verified benefits for the surgery clinic utilizing CPT and ICD codes provided for the most accurate quotes from insurance carriers.
  • Verified insurance benefits and obtained pre-authorizations before any medical procedures were performed.

Receptionist/ Dr

Hubert Williston
07.2004 - 08.2005
  • Answered a seven-line system and scheduled appointment
  • Routed any necessary calls
  • Collected copays, deductible, and any out of pocket expense owed by patient
  • Printed lab forms as ordered by physician for in office laboratory services with appropriate diagnosis codes
  • Updated all patient’s electronic files as needed.
  • Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
  • Kept reception area clean and neat to give visitors positive first impression.
  • Confirmed appointments, communicated with clients and updated client records.
  • Answered central telephone system and directed calls accordingly.
  • Provided clerical support to company employees by copying, faxing and filing documents.
  • Answered large volume of incoming calls daily to resolve customer issues and schedule appointments.

Education

Medical Insurance Billing & Coding - undefined

National Institute of Technology
Houston, TX
2004

Medical Insurance Billing and Coding certificate of completion -

Lee College
Baytown, TX
2002

High School Diploma - undefined

Ross S. Sterling High School
Baytown, TX
2001

Skills

  • Bilingual (English/Spanish)
  • Experienced coordinator
  • Self-Driven, focused, and proactive
  • Great under pressure and deadlines
  • Experienced completing duties under no or minimal supervision
  • Knowledgeable with eligibility and benefits
  • Experienced in billing, collections, appeals, and disputes
  • Experienced in reconciliation and accounts receivable
  • Experienced with patient statements, balances, and credit balances
  • Experienced with EOB, EOPs, R&S, and patient payments
  • Knowledgeable with
  • PPO, HMO, Medicare, Medicaid, Tricare, Worker’s Compensation, and MCOs
  • Knowledgeable with deductible, copays, and out of pocket expenses,
  • Knowledgeable with fee schedules
  • Experienced in credentialing
  • Familiar with carrier’s provider portals
  • Experienced with CMS 1500s
  • Familiar with ordering office supplies
  • Experience with photocopying, faxing, scanning, emails, and certified mail
  • Familiar with CAQH
  • Office Operations
  • Collections Standards
  • Payment Collection
  • HIPAA Guidelines
  • Data Entry
  • Dependable and Responsible

Languages

Spanish
Native or Bilingual

Timeline

MEDICARE ADVANTAGE TELESALES AGENT

TTEC
08.2023 - 12.2023

Realtor Sales Associate

EXp Realty, LLC
01.2019 - Current

Billing and Credentialing Clerk

PARS MRI
05.2015 - 03.2018

Medical Staff Office Coordinator

Bayshore Medical Center / East Houston Regional
07.2014 - 09.2014

Operations, Member representative

MCO / Community Health Choice
05.2014 - 07.2014

Billing and Credentialing Coordinator

Bay Area Rehabilitation Center
02.2008 - 04.2013

Registration, Insurance Verification Clerk

The Methodist Hospital San Jacinto
08.2005 - 03.2007

Receptionist/ Dr

Hubert Williston
07.2004 - 08.2005

Medical Insurance Billing & Coding - undefined

National Institute of Technology

Medical Insurance Billing and Coding certificate of completion -

Lee College

High School Diploma - undefined

Ross S. Sterling High School

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Edna Lopez