Esmeralda Mendoza
Santa Ana,CA
Summary
Dynamic Insurance Specialist with extensive healthcare experience, adept at navigating complex insurance processes and enhancing client relations. Proven track record in HIPAA compliance and documentation, successfully negotiating payment plans and improving patient access to resources. Bilingual in Spanish, fostering trust and effective communication with diverse populations.
Overview
21
21
years of professional experience
Work History
Insurance Specialist
Sanderling Renal Service
Santa Ana, CA
11.2024 - Current
- Conducted insurance eligibility verification for patient accounts, ensuring accurate coverage information.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Negotiated payment plan arrangements with medical billing departments on behalf of the patients experiencing financial hardship.
- Educated patients on available resources and community programs, increasing their access to needed services.
- Managed patient complaints professionally and efficiently while maintaining strict adherence to HIPAA regulations.
- Responded to patient concerns and questions with compassionate and knowledgeable service.
- Analyzed patient insurance information to verify coverage and eligibility for services.
- Collaborated with healthcare teams to resolve billing discrepancies and improve claim approvals.
- Led interdisciplinary team meetings to discuss patient outcomes and treatment plans.
- Managed complex patient cases, collaborating with multidisciplinary teams to develop personalized treatment plans.
- Interviewed clients, families, or groups to assess situations, limitations and issues and implement services to address needs.
- De-escalated stressful situations through individual and family crisis interventions.
- Improved client well-being by conducting comprehensive assessments and developing tailored intervention plans.
Insurance Specialist
DaVita
Irvine
04.2009 - 10.2022
- Collaborated with healthcare teams to address patient insurance inquiries and improve service delivery.
- Implemented process improvements that streamlined claim submissions and reduced error rates.
- Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
- Processed eligibility and benefits verification and authorization requests.
- Followed up on denials, late payments, extensions and other special circumstances.
- Acted as subject matter expert, answering internal, and external questions and inquiries.
- Monitored changes in insurance industry to stay compliant with relevant laws and regulations.
- Prepared and reviewed insurance applications to verify compliance with regulations.
- Built relationships with clients using active listening and issue resolution to provide excellent service.
- Negotiated with insurance underwriters to obtain better coverage and improved rates for clients.
- Conducted annual reviews of existing policies to update information.
- Navigated complex healthcare systems to assist patients in accessing necessary resources and support services.
- Educated patients on their rights, available services, and effective advocacy strategies for improved health outcomes.
- Responded to patient concerns and questions with compassionate and knowledgeable service.
- Monitored patient progress and provided emotional support.
- Provided emotional support to patients and families during challenging medical situations, fostering trust and rapport.
- Managed patient complaints professionally and efficiently while maintaining strict adherence to HIPAA regulations.
- Educated patients on available resources and community programs, increasing their access to needed services.
- Assisted patients in navigating complex insurance processes, leading to successful claim resolutions and reduced financial burdens.
- Negotiated payment plan arrangements with medical billing departments on behalf of the patients experiencing financial hardship.
Administrative Assistant
DaVita
Santa Ana, CA
03.2007 - 04.2009
- Developed and maintained filing systems to enhance document retrieval processes.
- Assisted in preparing reports, contributing to data accuracy and timely submissions.
- Provided exceptional customer service, addressing patient inquiries and concerns effectively.
- Collaborated with healthcare professionals to streamline communication and enhance team collaboration.
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
- Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
- Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.
- Assisted patients in completing intake forms and obtaining accurate medical histories.
- Collaborated with healthcare team members to develop patient care plans tailored to individual needs.
- Built strong relationships with patients through effective communication skills that foster trust in the clinic''s commitment to quality care.
- Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
Home Health Caregiver
Cambrian Home Care
Orange, CA
08.2005 - 01.2007
- Provided compassionate care to clients, enhancing their quality of life and emotional well-being.
- Assisted with daily living activities, ensuring safety and comfort for clients in home environments.
- Administered medication and monitored health conditions, maintaining accurate records for client care plans.
- Developed strong relationships with clients and families, fostering trust and open communication.
- Maintained cleanliness and organization within client homes, promoting a safe living environment.
- Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
Education
No Degree - Certified Nursing
Casa Loma College
Hawthorne, CASkills
- Documentation
- Client relations
- Business planning
- Insurance practices
- Customer engagement
- Relationship building
- HIPAA compliance
- FLUENT IN SPANISH
Timeline
Insurance Specialist
Sanderling Renal Service
11.2024 - Current
Insurance Specialist
DaVita
04.2009 - 10.2022
Administrative Assistant
DaVita
03.2007 - 04.2009
Home Health Caregiver
Cambrian Home Care
08.2005 - 01.2007
No Degree - Certified Nursing
Casa Loma College