Jason Lopez
San Antonio,TX
Summary
Dynamic Contract Configuration Specialist with proven expertise at WellMed Medical Management, adept at claims processing and regulatory compliance. Recognized for achieving a production rate of 14 claims per hour, enhancing efficiency. Skilled in data analysis and inventory management, fostering team collaboration to drive success in high-pressure environments.
Overview
21
21
years of professional experience
Work History
Contract Configuration Specialist
WellMed Medical Management - United Health Group
San Antonio, TX
03.2019 - Current
- Achieved production rate of 14 claims per hour, boosting efficiency and accuracy.
- Configured contracts to comply with paper specifications and regulatory mandates.
- Served as subject matter expert for Federally Qualified Health Center and Rural Health Clinic contracts.
- Processed claims in IKA and Cosmos systems to ensure accurate adjudication.
- Addressed all aged claims in inventory to ensure timely filing.
- Generated Inventory Reports for team during absence of Team Lead.
Referral Specialist
Superior Healthplan
02.2018 - 03.2019
- Issue authorizations for facility and provider offices for emergent inpatient admissions via fax, or by phone
- Have kept a 65 daily production in accordance with Superior Health Plan processes
- I have been trained in claims for Superior Medicaid, Ambetter, and all Superior Medicare Plans
Medicare Auditor
CGI
12.2015 - 02.2018
- Responsible to audit Medicare claims to ensure payment was made correctly for medical request
- If payment was made in error when primary insurance or third part liability insurance should have paid primary, I would submit request for payment from other insurance and apply payment in system
- Maintained a 50 account production daily in accordance with CGI policy
Government Logging Team Lead
HCA/Parallon
12.2014 - 12.2015
- Government Logging Team Lead Monday thru Friday
- Helped in the process of hiring current analyst to grow the team we have now
- I help ensured the analysts are following government guidelines for Medicare, Medicaid and Tricare
- I worked with team members to come up with training process for new upcoming employees in our department
- Responsible to ensure all daily production is reviewed and worked by team
- Coordinate with manager during the day on changes within the inventory and team members
- Worked daily and monthly reports, monthly QA, coaching team members and additional education when needed
- I am currently in process training for a new PARS inventory web tool
- I was chosen by my Director and CFO to engage in more intensive training to be the Training Coordinator when the system comes available
Centralized Insurance Verification Team Lead
HCA/Parallon
07.2013 - 12.2014
- Team Lead every Saturday, helped develop and maintain a growing team to work on Saturdays, ensuring twenty four hour payers are worked, reviewed for an authorization based on payer contracts
- Challenge was working on Saturdays with a limited team of six or seven comparable to Monday - Friday team of twenty plus
- I worked with management & team members to create processes to work efficiently while maintaining a happy and fun environment, but not losing focus on the goal working all inventory
- Scheduled to work every Sunday, worked three
- Five hours based on inventory, this allowed for no team member to come in on a Sunday and was welcomed by all team members
- Responsible to ensure all daily production is reviewed and worked by team
- Coordinate with manager and co-team lead during the day on changes within the inventory and team members
- Worked daily and monthly reports, monthly QA, coaching team members and additional education when needed
- Assisted on creating new web tool for all inventory with web development team
- I used my experience with business objects and gave all logic and equations to prioritize how accounts come to the team to be worked
Charity Analyst
HCA/Parallon
02.2012 - 07.2013
- Following Parallon/HCA Charity Policies, I verifier patients application and if applicant met federal guidelines to be approved or denied for charity assistance
- Created business object scripts to run zip code charity write offs and in turn this helped the department work a faster pace and reporting structure was maintained
Patient Access
HCA/Parallon
12.2008 - 12.2012
- Registrar working at Methodist Stone Oak, Methodist Specialty & Transplant, and MASH
- Registered patients for scheduled procedure and handled all other needs and admission from patients or transfers
- I worked ER at MSOH and MSTH, ensuring all information was taken appropriately and timely
- Noted accounts with correct text and obtained all demographic information and insurance
- Handled patient’s responsibility, and maintained a ninety five QA average for the month
Centralized Insurance Verification
HCA/Parallon
12.2010 - 02.2012
- Post CIV Verifier working with Methodist Health Care System & St
- David’s Hospitals
- Reviewed, verified, and if needed initiated authorizations for all accounts, based on patients status and payer
- Worked all assignments assigned for the day, and when completed I worked with management to help the team for the daily goal of all inventory to be completed
Customer Service Associate
Wal-Mart
06.2004 - 12.2008
- Responsible to return all merchandise to appropriate departments, worked cashiering on assigned days
- Grew to work special projects with store manager including inventory, ordering, and customer service focus
- Recognized for having outstanding customer service
Education
Bachelor of Business Administration - Business Administration
University of Texas
San Antonio, TX05.2006
Bachelor of Business Administration - Business Administration
Texas A&M Corpus Christi
Corpus Christi, TX05.2004
High School Diploma - General Education
Highlands High School
San Antonio, TX05.2003
Skills
- Contract configuration
- Claims processing
- Regulatory compliance
- Inventory management
- Data analysis
- Report generation
References
References available upon request.
Timeline
Contract Configuration Specialist
WellMed Medical Management - United Health Group
03.2019 - Current
Referral Specialist
Superior Healthplan
02.2018 - 03.2019
Medicare Auditor
CGI
12.2015 - 02.2018
Government Logging Team Lead
HCA/Parallon
12.2014 - 12.2015
Centralized Insurance Verification Team Lead
HCA/Parallon
07.2013 - 12.2014
Charity Analyst
HCA/Parallon
02.2012 - 07.2013
Centralized Insurance Verification
HCA/Parallon
12.2010 - 02.2012
Patient Access
HCA/Parallon
12.2008 - 12.2012
Customer Service Associate
Wal-Mart
06.2004 - 12.2008
Bachelor of Business Administration - Business Administration
University of Texas
Bachelor of Business Administration - Business Administration
Texas A&M Corpus Christi
High School Diploma - General Education
Highlands High School
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