Janie Chapa
San Antonio,Texas
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
10
10
years of professional experience
Work History
Insurance Coordinator
LifeStance Behavioral Health
06.2023 - Current
- Assist our Insurance Collections team with accurate, detailed, and thorough medical billing processes, while utilizing their collections billing knowledge to ensure that claims are processed and paying accurately
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained compliance with local, state and federal regulations governing insurance, Medicare and Medicaid requirements.
- Filed and tracked insurance claims and communicated claims status to patients.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Maintained confidentiality of patient finances, records, and health statuses.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Coordinated with contracting department to resolve payer issues.
- Processed and recorded new policies and claims.
Care Advocate
United Healthcare
10.2020 - 06.2023
- Telephonic outreaches to members who have been recently hospitalized
- Working closely with a team of nurses and social workers to help direct members to needed services such as caregiver support, training, and community resources
- Researched issues and took appropriate action to resolve issues within turnaround time requirements and quality standards.
- Contacted third-party payors to obtain and confirm authorization for services and communicated necessary related clinical information.
- Worked with enrollees to identify gaps in care or obstacles to care.
- Conducted patient assessments to determine appropriate levels of care.
- Entered timely and accurate data into electronic medical records to communicate member needs.
- Met with community providers to foster good rapport and relationships and identify new programs.
- Responded to patient concerns and questions with compassionate and knowledgeable service.
- Worked effectively with staff from all departments to coordinate resolutions.
- Entered details into computer systems and managed database of information.
- Educated patients and families on healthcare options and financial support resources.
- Facilitated communication between patients, families and healthcare providers to support comprehension.
- Collected and analyzed patient feedback to evaluate quality of care.
- Collaborated with healthcare professionals to facilitate high-quality comprehensive care.
Insurance Claims Specialist
Alamo Mental Health Group
08.2013 - 03.2021
- Answered a high volume of calls, scheduling appointments and relaying patient messages to the doctors
- Submitting corrected claims and appeals to health insurances
- Billing primary and secondary insurances
- Posting insurance payments.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Reordered medication to maintain adequate supply.
- Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Verified insurance and communicated coverage to staff and patients.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
Education
Bachelor of Arts - Psychology
Texas A&M University
San Antonio, TX12.2023
Languages
Spanish
Native or Bilingual
Timeline
Insurance Coordinator
LifeStance Behavioral Health
06.2023 - Current
Care Advocate
United Healthcare
10.2020 - 06.2023
Insurance Claims Specialist
Alamo Mental Health Group
08.2013 - 03.2021
Bachelor of Arts - Psychology
Texas A&M University
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