Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

Litza Flores

Dover,NJ

Summary

Dynamic Account Resolution Specialist with a proven track record at PromptCare Companies, excelling in claims processing and client relationship building. Recognized for reducing claim denials through meticulous documentation and effective problem-solving. Adept at financial collections, delivering exceptional customer service while maintaining compliance with industry regulations.

Overview

18
18
years of professional experience
1
1
Certification

Work History

Account Resolution Specialist

PromptCare Companies
05.2020 - 06.2025
  • Assessed individual situations and developed effective and appropriate resolutions.
  • Created detailed documentation for each case handled, ensuring proper record-keeping.
  • Developed customized reports for management, providing valuable insights into outstanding receivables and collection performance metrics.
  • Provided exceptional customer service, handling inquiries and resolving issues in a professional manner.
  • Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
  • Researched accounts and completed due diligence to resolve collection problems.
  • Responded to customer inquiries and provided detailed account information.
  • Monitored customer accounts for payment delinquency and initiated collection efforts.
  • Researched billing errors and discrepancies to initiate corrective action.

Prior Authorization Representative

PromptCare Companies
06.2019 - 05.2020
  • Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
  • Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Processed new medication and refill requests for authorization.
  • Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
  • Reduced claim denials by thoroughly reviewing and analyzing medical necessity documentation before submitting for approval, ensuring all criteria were met.
  • Supported continuous improvement initiatives by actively participating in meetings, providing feedback, and suggesting areas for improvement.
  • Increased accuracy of insurance coverage validation by utilizing available tools and resources to verify eligibility requirements quickly.
  • Contacted insurance companies to obtain prior authorization for medical procedures and medications.
  • Developed strong relationships with key stakeholders such as physicians, nurses, pharmacists, and office managers to support seamless coordination during the prior authorization process.
  • Resolved patient billing inquiries and other issues efficiently.
  • Demonstrated adaptability by managing multiple priorities simultaneously, ensuring all tasks were completed accurately and on time.
  • Analyzed medical records and other documents to determine approval of requests for authorization.

Medical Biller

Atlantic Health System
06.2007 - 06.2019
  • Verified insurance of patients to determine eligibility.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
  • Ensured timely payments from insurance providers through submission of accurate and complete claims.
  • Maintained compliance with industry regulations by staying updated on changes to medical billing codes and requirements.
  • Collaborated with healthcare providers, ensuring accurate documentation for seamless billing operations.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Trained new team members in medical billing software, increasing efficiency within the department.
  • Organized filing system for patient records, expediting access to essential documents when needed.
  • Assisted patients in understanding insurance benefits, leading to a positive experience during their visit.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.
  • Conducted detailed analyses of billing cycles to identify patterns and implement strategies for reducing delays in payments.
  • Consolidated patient data from multiple sources to streamline billing process and improve record accuracy.
  • Responded to customer concerns and questions on daily basis.
  • Monitored outstanding invoices and performed collections duties.
  • Generated monthly billing and posting reports for management review.

Education

Certificate - Medical Billing

Chubb Insitute
Parssipany, NJ
05-2005

High School Diploma -

Dover High School
Dover, NJ
06-2003

Skills

  • Client relationship building
  • Claims processing
  • Goal-oriented mindset
  • Documentation skills
  • Data entry proficiency
  • Research
  • Claim handling
  • Debt collection
  • Active listening
  • Outbound calling
  • Account review
  • Credit and collections
  • Issue investigation
  • Insurance policies
  • Billing problem resolution
  • Investigation due diligence
  • Teamwork
  • Customer service

Certification

Medical Billing Certificate

Languages

English
Full Professional

Timeline

Account Resolution Specialist

PromptCare Companies
05.2020 - 06.2025

Prior Authorization Representative

PromptCare Companies
06.2019 - 05.2020

Medical Biller

Atlantic Health System
06.2007 - 06.2019

Certificate - Medical Billing

Chubb Insitute

High School Diploma -

Dover High School

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