Frances Guzman
Morrisville,PA
Summary
Experienced quality-focused professional with 10+ years in medical administration, quality assurance, and customer success. Proven track record of implementing efficient processes to enhance compliance, accuracy, and customer satisfaction. Skilled in leading cross-functional teams, optimizing workflows, and fostering a collaborative environment that drives performance and achieves company goals. Proficient in tools such as JIRA and Salesforce, with a strong focus on data integrity and regulatory compliance. Recognized for exceptional communication skills, a customer-focused approach, and a commitment to continuous improvement in service delivery. Committed to enhancing service quality through meticulous attention to detail and proactive problem-solving.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Virtual Patient Support Processor
Galileo Health
, Remote
04.2022 - Current
- Support healthcare providers by managing communication and documentation with a quality assurance focus.
- Oversee the timely and precise processing of referrals, and organizing medical records to maintain compliance with healthcare regulations leading to a 20% improvement in processing efficiency.
- Regularly updated patient information in EHR systems, performing quality checks contributing to a 98% accuracy rate in patient data.
- Collaborated effectively with cross-functional teams to enhance patient experiences, implementing process improvements that reduced response times by 15%.
- Address patient inquiries on services and billing precisely, schedule appointments, and coordinate follow-up care.
- Conduct risk adjustment evaluations (HEDIS) for Medicare and Medicaid, ensuring accurate data capture and reporting.
- Monitor referral timelines and facilitate clear communication between patients and providers, upholding high-quality standards in all interactions.
Medical Office Assistant and Billing Specialist
JARE Medical Services
San Juan, Puerto Rico
06.2007 - 04.2013
- Implemented a new electronic charge capture process, streamlining billing operations and reducing billing discrepancies by 25%, which enhanced regulatory compliance and improved cash flow for the organization.
- Maintained strict client record confidentiality through secure, compliant filing practices, adhering to HIPAA guidelines and quality assurance standards.
- Educated patients on medications and treatment plans, providing clear and accurate information to support understanding.
- Efficiently verified insurance details and collected co-payments, fostering a seamless and transparent patient experience.
- Submitted diagnosis codes with precision, ensuring timely reimbursements and proactively communicating financial responsibilities to patients, contributing to a 15% reduction in billing-related inquiries.
- Resolved billing issues with insurers effectively, managing patient files with precision and compliance.
- Conducted comprehensive risk evaluations and met regularly with medical insurance staff to review cases, optimizing claim processes, and achieving a 20% reduction in claim processing time.
- Reviewed insurance coverage thoroughly and explained associated costs to patients, enhancing transparency and building trust, resulting in a measurable increase in patient satisfaction.
- Reviewed insurance coverage in detail, explaining associated costs to patients to enhance transparency and trust.
- Consistently integrated quality assurance protocols across all tasks, improving accuracy and compliance, and contributing to a 98% accuracy rate in patient records and claims, which strengthened overall patient satisfaction and operational reliability.
Retail Sales Team Lead Associate
Godiva Chocolatier Inc
Carolina, Puerto Rico
02.2007 - 08.2009
- Drove a 15% increase in sales by enhancing customer engagement strategies, providing tailored product recommendations, and fostering a welcoming shopping environment that encouraged repeat business and customer loyalty.
- As a team leader, motivated and guided team members, fostering a collaborative and high-performance environment that contributed to a 10% boost in team productivity.
- Strategically arranged merchandise to maximize visual appeal and attract shoppers, increasing sales by 12% through effective displays.
- Efficiently handled transactions, maintaining an organized and welcoming store environment that improved the customer experience.
- Developed targeted sales strategies, leading to a 20% increase in customer satisfaction scores.
- Monitored the daily performance of the sales team to ensure goals were met, implementing improvements that enhanced overall team efficiency.
- Established strong relationships with customers by consistently delivering excellent service, which helped increase repeat customer visits by 18%.
Bank Teller, Sales and Financing
Banco Popular
San Juan, Puerto Rico
03.2004 - 06.2006
- Maintained optimal cash levels in the teller area and ensured accurate balancing of cash drawers, ATMs, and vaults, implementing quality assurance protocols that reduced cash discrepancies by 20%.
- Collaborated with management to achieve sales goals and enhance customer engagement, applying quality standards that contributed to a 15% increase in customer satisfaction scores. Adhered strictly to bank policies to safeguard customer assets and prevent fraud, consistently supporting a secure banking environment.
- Adhered strictly to bank policies to safeguard customer assets and prevent fraud, consistently supporting a secure banking environment.
- Educated clients on digital banking channels, successfully promoting self-service options, which led to a 25% increase in digital banking adoption.
- Responded promptly to customer inquiries and resolved complaints effectively, upholding high service quality.
- Assisted in compliance efforts through regular audits and reconciliations, and processed transactions with accuracy, contributing to a 100% compliance record in operational audits.
Manager
Econo Supermarket
Trujillo Alto , Puerto Rico
04.2002 - 06.2005
- Supervised team performance through effective training and scheduling, resulting in a 15% increase in staff productivity
- Implemented targeted strategies to boost sales and customer engagement, contributing to a 10% year-over-year increase in sales.
- Conducted regular inspections to ensure safety and sanitation compliance, maintaining a spotless health inspection record.
- Resolved customer complaints efficiently, enhancing customer loyalty and improving satisfaction scores.
- Managed cash flow, reconciliations, and reporting to maintain strict compliance, achieving zero discrepancies in financial audits
- Monitored sales performance consistently, adjusting strategies to align with and exceed business goals.
Education
Some College (No Degree) - Business Administration
University of Puerto Rico
CarolinaSkills
- Issue Revolution and Troubleshooting
- Compliance and Regulatory Adherence
- Troubleshooting
- Technology research
- Mentoring and training
- Automated inventory processes
- Effective Communication Skills
- Bilingual Communication (English and Spanish)
- High Attention to Detail
- JIRA
- Documentation and materials
- Critical Thinking and Problem Solving
- Salesforce
- Electronic Medical Records
- Data Management
- Customer Relationship
- Patient Care
- Effective Communication Skills
- Decision-Making and Leadership
- HIPAA Compliance
- Medical Records Processing
- Team Collaboration
- Complaint resolution
- Positive and professional
- Staff education and training
- Research
- Health information management
- Medical terminology understanding
- ICD-9 coding experience
- Medical office administration
- Medical records audits
- Medical record safeguarding
- Release of information paperwork
- Written and verbal communication
- Microsoft Excel proficiency
- Audit management
- Strategic Planning
- Patient education and counseling
Certification
- Medical Interpreter- America Against Language Barriers February 2022
- Medical Office Assitant and Administration- MedCerts November 2019
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
References
References available upon request.
Timeline
Virtual Patient Support Processor
Galileo Health
04.2022 - Current
Medical Office Assistant and Billing Specialist
JARE Medical Services
06.2007 - 04.2013
Retail Sales Team Lead Associate
Godiva Chocolatier Inc
02.2007 - 08.2009
Bank Teller, Sales and Financing
Banco Popular
03.2004 - 06.2006
Manager
Econo Supermarket
04.2002 - 06.2005
Some College (No Degree) - Business Administration
University of Puerto Rico
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