HARLEYANN DIAZ
Effort,USA
Overview
16
16
years of professional experience
Work History
Care Connector- EPSDT
AmeriHealth Caritas
Remote
03.2025 - Current
- Supported daily operations of integrated care management program interventions.
- Processed calls from members, providers, and internal departments in contact center environment.
- Delivered educational materials to members and implemented strategies to enhance healthcare adherence.
- Coordinated care services for members addressing diverse health needs.
- Guided members in accessing healthcare resources and community services.
- Arranged transportation services for clients to medical appointments and essential activities.
Operations Manager
Alexander Tutoring Center
Remote, PA
01.2024 - 01.2025
- Orchestrating daily operations at Alexander Tutoring using a CRM system and online software systems
- Responded promptly to inquiries from customers or clients regarding products or services offered by the company.
- Prepared invoices and drafted memos for executives.
- Coordinated 10 schedules and workflow using online calendaring system and Salesforce.
- Coordinated the distribution of annual W-2 forms to employees.
- Helped with onboarding process for new hires, ensuring all documentation was completed accurately and in a timely manner.
Claims Specialist
Clearbill
Effort, PA
08.2017 - 01.2020
- Managed 15 Midwife accounts in NY, NJ and CA
- Claims Specialist with a focus on Appeal Letters and Claims Correction
- Maintained accurate records of all patient visits and updated electronic health records
- Answered incoming calls, managed voicemails, and responded to email inquiries
- Processed financial documents such as prior-authorizations, SCA's, appeals and claims
- Provided exceptional customer service to ensure customer satisfaction
- Ensured prompt resolution of customers' inquiries via phone or email
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Researched insurance plans to determine coverages and benefits available.
- Liaised between physician, site of service and billing department to obtain appropriate documentation.
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
Medical Office Manager
The Brain Resource Center
New York, NY
02.2013 - 05.2016
- Managed a team of five employees and served as the Executive Assistant to the Director.
- Provided exceptional customer service to ensure customer satisfaction.
- Supervised patient billing, collection and financial counseling and assisted with cash posting.
- Scheduled appointments for patients in accordance with their individual needs and preferences.
- Performed data entry and processing into system databases and troubleshot minor computer issues.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
- Managed accounts receivable for the practice, ensuring timely payments from insurance companies and patients.
- Trained new staff on office procedures, software programs and customer service protocols.
- Handled telephone inquiries from patients regarding appointment scheduling or general questions about the practice's services.
Customer Support Representative
East Meadow Family Practice
East Meadow, NY
01.2012 - 01.2013
Executive Assistant to the President
Big Apple Worldwide
Westbury, NY
01.2010 - 01.2012
Skills
- Claim denials management
- Insurance verification
- Claims processing
- EOB analysis
- Medical software navigation
- Claim appeals handling
- Payment posting
- CPT knowledge
- Verbal and written communication
- Multitasking and organization
- ICD-10 coding
- HIPAA compliance certification
- Medical billing
- Customer service
- Proficient in Salesforce
- Proficient in Slack
- Proficient in Navinet
- Proficient in Epic
- Proficient in MS Office
- Proficient in Google Calendar Software
- Staff mentoring & leadership
- Schedule management
- Eligibility verification
- Care Gaps and resources
- Strategic planning
Timeline
Care Connector- EPSDT
AmeriHealth Caritas
03.2025 - Current
Operations Manager
Alexander Tutoring Center
01.2024 - 01.2025
Claims Specialist
Clearbill
08.2017 - 01.2020
Medical Office Manager
The Brain Resource Center
02.2013 - 05.2016
Customer Support Representative
East Meadow Family Practice
01.2012 - 01.2013
Executive Assistant to the President
Big Apple Worldwide
01.2010 - 01.2012