Jake Rellos
Gunter,TX
Summary
Team player with nine years of experience as a patient access and billing leader in the medical field. I have successfully managed authorization operations for multiple hospitals starting with HCA. Part of my expertise lies in optimizing processes and improving efficiency across the medical industry. My primary motivation in this field is my desire for an Empowering work-culture and striving for excellent patient service while providing the necessary skills to keep the insurance and revenue cycle functioning appropriately.
CAREER HIGHLIGHTS:
I successfully managed and led remote teams of 12 or more agents handling multiple claims and intake requests for authorizations, billing, and medical patient access in the financial arm of the medical industry. In 2025 I left HCA and started with Paragon infusion centers, utilized my skills from outpatient hospitals and applied my knowledge within the Speciality infusion space, I initiated protocols for successful claims, analyzed targets and met production standards for infusions. CMS registration learning, clinic oversight and front end intake while leading teams and executing targets I developed payer knowledge for speciality infusions while learning and updating payer criteria across departments. I continue to learn about speciality drugs and the Buy and Bill process. I also continue to learn about Billing Regulations within the speciality pharmacy industry
Overview
10
10
years of professional experience
Work History
Referral Specialist III
Paragon Healthcare
Plano, TX
01.2025 - Current
- Liaised with healthcare providers to resolve referral issues and enhance communication.
- Streamlined referral processes to increase efficiency and reduce turnaround times.
- Maintained accurate records in referral tracking system for improved data integrity.
- Coordinated infusion therapy schedules to ensure timely patient treatment and optimal resource allocation.
- Streamlined infusion protocols to improve operational efficiency and reduce treatment wait times for patients.
- Trained new staff on infusion procedures and best practices, fostering a collaborative team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Accurate Cost estimates for therapy’s
- Benefit verification for speciality pharmacy
- Managed patient intake processes, collecting essential medical histories and facilitating seamless communication with healthcare teams.
- Developed and maintained comprehensive patient records using electronic health record systems to enhance data accuracy.
- Collaborated with multidisciplinary teams to address patient needs, ensuring high-quality care delivery at all stages of treatment.
- Conducted quality assurance checks on equipment and supplies, maintaining compliance with safety standards and regulations.
- Stayed up to date for clinical payer criteria for new and existing speciality infusions
- Updated payer guidelines for medical necessity and successful claims for speciality pharmacy
- Paid attention to detail while completing assignments.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Strengthened communication skills through regular interactions with others.
- Adaptable and proficient in learning new concepts quickly and efficiently.
Billing Team Lead
HCA
Remote
10.2015 - 01.2025
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Facilitated successful cross-functional collaborations for the completion of key projects, fostering strong working relationships among team members.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
- Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for procedures.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
- Reduced errors in billing by accurately maintaining patient records with updated insurance information.
- Streamlined administrative tasks for increased efficiency in daily operations.
- Improved patient satisfaction by implementing efficient healthcare management processes and procedures.
- Cross trained staff
- Data analysis and reports to senior leadership
- Helped implement Vendor efficiencies and out of network payor updates portal
- Streamlining outpatient orders and improving accuracy of schedules
- Daily processes to enforce Data privacy requirments to staff, HIPPA education
- Helped promote patient satisfaction Quota's by implementing call recording and monitoring into daily workflow for leads.
- Built Stat processes to handle rush service authorizations to meet demands of fast rushed outpatient service on behalf of physicians and facilities
- Provided cover plans for staff on PTO,
- Powerpoint presentations, trends & reports
- Streamlined workflows by identifying bottlenecks in existing systems and proactively addressing these challenges through appropriate solutions implementation.
- Ensured compliance with industry regulations and legal requirements by implementing comprehensive policies and training programs for staff members.
- Accomplished multiple tasks within established timeframes.
- Maintained professional, organized, and safe environment for employees and patrons.
- Maintained professional demeanor by staying calm when addressing unhappy or angry and emotional patients.
- Enforced protocol and performed coaching and regulation of staff
- Managed daily productivity by setting up logs and providing leadership with daily productivity goals
- Assisted with interdepartmental for process changes and brought compliance department inside of the changes for necessary oversight
- Implemented strategy for technology tools working along IT department and stakeholders for new programs and implementation strategy
- Increased team productivity by implementing streamlined processes and effective communication strategies.
- Enhanced patient satisfaction by providing compassionate and attentive care.
- Reduced stress for patients and families through effective communication and empathetic support.
- Assisted hospital radiology, surgery and registration departments with essential resolutions over the phone,, streamlining workflow and increasing efficiency for patient arrival at registration
- Facilitated smooth transitions between shifts by maintaining thorough documentation of patient care activities and observations.
- Streamlined billing operations to enhance efficiency and reduce claim denials.
- Trained and mentored junior staff on best practices in medical billing procedures.
- Implemented new software tools to improve accuracy in claims processing.
- Collaborated with healthcare providers to resolve billing inquiries and disputes effectively.
- Conducted regular audits to identify discrepancies and enforce quality control standards.
- Developed training materials to support ongoing education for billing staff.
- Analyzed trends in billing data to inform strategic decisions and optimize revenue cycle management.
- Maximized reimbursements, negotiating with insurance companies to ensure accurate payments for services rendered.
- Oversaw patient payment plans, ensuring timely remittance while maintaining compassionate customer service practices for those experiencing financial hardships.
- Maintained strict adherence to HIPAA privacy guidelines, protecting sensitive patient information at all times during the billing process.
- Mentored junior staff members, fostering professional growth through skill development opportunities and constructive feedback.
- Managed accounts receivable aging reports, prioritizing collections efforts for overdue balances.
- Demonstrated leadership skills by delegating tasks effectively and providing support to team members, contributing to a cohesive and high-performing billing department.
- Analyzed trends in denial rates to identify areas for process improvement and training needs.
- Improved team productivity with regular training sessions on new software programs and tools utilized in the precertification process.
- Reduced patient wait times for approval by diligently reviewing medical records and obtaining necessary documentation.
- Developed comprehensive knowledge of various insurance plans, policies, and coverage limitations to provide accurate guidance to patients and providers.
- Streamlined precertification processes by implementing efficient tracking systems and prioritizing urgent cases.
- Analyzed trends in denials or authorization delays to identify opportunities for improvement within the precertification department.
- Mitigated potential delays in service delivery through proactive identification of potential roadblocks within the precertification process.
- Increased accuracy of submitted claims through meticulous attention to detail in verifying insurance eligibility and benefits.
- Expedited treatment commencement by promptly acquiring authorizations for medically necessary services within required timeframes.
- Processed patient registrations efficiently, ensuring accuracy and compliance with healthcare regulations.
- Managed data entry for patient information into electronic health record systems.
- Completed registration paperwork, verifying accurate patient information.
- Answered patient questions and inquiries regarding registration process and documentation.
- Managed high call volumes while accurately scheduling appointments and directing calls to appropriate departments as needed.
- Provided training to new registration clerks on policies, procedures, and best practices for maintaining an efficient workflow within the department.
- Entered patient information into payment system accurately for billing purposes.
- Coordinated scheduling for patient follow-up appointments in accordance with physician requests.
- Assisted patients with questions or concerns about their appointments, addressing any issues promptly and professionally.
- Served as a liaison between patients, clinical staff, and administrative personnel to facilitate optimal communication and coordination of care.
- Safeguarded patient privacy with strict adherence to data security protocols related to electronic health records.
- Updated patient contact information to support accurate electronic medical records.
Education
Medical Administrator - Hospital Administration
Collin Community College
Online Course CreditsGED -
Torrance Adult School
Torrance CA01.2011
Skills
- Assisted with project development for new program roll outs to better understand workflows while creating open feedback loops to drive team performance
- Performed service recovery phone calls for patients and physician staff and provided open feedback loops for continued strategy
- Trained staff on Insurance portals, and 3rd party Utilization management systems
- Clinical documentation for Buy and Bill and PBM systems
- IV therapy expertise and drug therapy training
- Speciality pharmacy Healthcare regulations
- Verbal and written communication
- Policy interpretation
- Billing systems and software
- Invoice processing
- Claim submission and Pre Determinations for speciality drug rollouts
- POS system operation, epic, cerner, meditech, next gen, availity
- OTC recommendations and CME
- Infusion billing and claims
- Speciality Pharmacy terminology and training
- Assisted leadership with New speciality drug programs to understand foundation assistance, cost estimate quotas and targets
- Executed strategy for teamwork to achieve results in successful infusion claims, strategies tailored to successful claims to avoid denials , and meet department goals
Education
true
Timeline
Referral Specialist III
Paragon Healthcare
01.2025 - Current
Billing Team Lead
HCA
10.2015 - 01.2025
GED -
Torrance Adult School
Medical Administrator - Hospital Administration
Collin Community College