Summary
Overview
Work History
Education
Skills
Timeline
Generic

Jazmine Varela

El Paso,TX

Summary

Energetic and enthusiastic medical professional, looking to obtain a permanent position in the medical field to succeed in fast-paced and deadline-driven professional environment, improving business compliance, workflow and processes through detailed audits and optimization recommendations. Tackle new challenges with a company that values dynamic skills and a strong work ethic which will allow to learn both sides of the administrative and clinical areas of any organization.

Overview

11
11
years of professional experience

Work History

Claim Operational Auditor / Business Analyst

Superior Health Plan
11.2021 - 10.2023
  • Perform front end operational audits and assist in development of value-added feedback regarding potential negative impact to claims accuracy
  • Investigate and report conflicts and/or variances of operational processing guidelines that are not compliant with state regulations and/or executed provider contracts
  • Research statutory requirements and ensure compliance of all operations that impact claim accuracy
  • Conduct audit interviews with front line staff in all functional areas that fall under claim operations
  • Test, create flow charts and map operational processes that touch outcome of claims accuracy
  • Evaluate internal processes and/or controls to identify non-compliance issues and improvement opportunities
  • Create audit memos to document audit findings, which will result in audit recommendations, reports and claims audit criteria enhancements.
  • Prepared working papers, reports and supporting documentation for audit findings.
  • Executed audit phases and entered data into accounting software for analysis.

Senior Customer Service

Superior Health Plan
05.2016 - 11.2021
  • Assisted the facility with their billing & coding needs while providing excellent customer service
  • Answered incoming phone calls in professional manner
  • Used current material to answer inquiries regarding claims, eligibility, covered benefits and authorization inquires
  • Provided first call resolution
  • Working with appropriate internal/eternal resources, completing necessary follow-ups and ensuring closure of inquiry
  • Work with other departments on cross functional task and projects
  • Maintain performance and quality standards based on established call venter metrics and including turnaround times.

Customer Representative

Alorica
04.2015 - 02.2016
  • Help customers with any installation, would take payments for upsell and would go ahead and assist with any questions on their DirecTV programming, equipment, or on their bill
  • Took role as a lead, assist agents on questions or take supervisor calls
  • Cross-trained and provided backup support for organizational leadership.
  • Promptly responded to inquiries and requests from prospective customers.
  • Participated in team meetings and training sessions to stay informed about product updates and changes.

Medical Customer Rep

HGS, Blue Cross Blue Shield
09.2014 - 04.2015
  • Take calls regarding any information based on their insurance such as benefits and eligibility, their payment, if delinquent, would reinstate member as soon as payment would go through generate eligibility from to DR's,
  • Assist in prior authorization calling nurses for status, provide any additional information to get authorized, call pharmacy to make sure member can get their medications fix any errors on their application
  • Assist other agents to reinstate members and questions on authorizations as that was mine line of work previously, would help agents to understand coinsurance and deductible aspect of insurances.
  • Conducted surveys to determine customer opinion of products and services.
  • Retained dissatisfied customers by offering empathetic listening skills followed by effective problem-solving approaches tailored to each individual case.

CVS

IGATE
02.2014 - 10.2014
  • Resolve patients applications for Medicare to obtain their medication.
  • Resolve any mistake on applications, birth date, date of death, name or any errors that has occurred on application from letting patients get their medication.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Managed time efficiently in order to complete all tasks within deadlines.
  • Built professional relationships with customers and business partners to establish trust and credibility.

Medical Receptionist

Adult and Children's foot
01.2013 - 12.2013
  • Answer phones, schedule appointments, greet patient's, assemble charts, file charts, verify insurance, authorization, take payment, scheduled surgery's, fix patients chart for surgery's would review explanation of benefits, sign in and out patients, assist with translation and read out copays and deductibles.
  • Facilitated effective communication between patients, medical staff, and insurance companies to ensure seamless coordination of care.
  • Managed multi-line phone system and pleasantly greeted patients.

Education

Bachelors - Health Administration

Southwest University
El Paso, TX
01.2016

Associate of Applied Science - Billing And Coding

Southwest University
El Paso, TX
01.2013

Medical record & Health information specialist - Diploma

Southwest Career College
El Paso, TX
01.2011

High School Diploma -

Riverside High School
El Paso, TX
01.2008

Graduated Medical Assistant - Certificate

Career Centers of El Paso
El Paso, TX
01.2000

Skills

  • Policy Modifications and Updates
  • Teamwork and Collaboration
  • Problem-Solving
  • Insurance Claim Forms Review
  • Customer Service
  • Microsoft Office
  • Billing Software
  • Decision Making
  • Time Management
  • Account Management
  • Customer Data Confidentiality
  • De-escalation Techniques
  • MS Office
  • Excel
  • HIPAA Guidelines
  • Front Desk Operations
  • Referral Verification
  • Cleaning and Sterilizing
  • Medical Recordkeeping
  • Appointment Scheduling
  • Records Management
  • Telephone Etiquette
  • Claim Forms
  • Medical Coding
  • Insurance Authorizations

Timeline

Claim Operational Auditor / Business Analyst

Superior Health Plan
11.2021 - 10.2023

Senior Customer Service

Superior Health Plan
05.2016 - 11.2021

Customer Representative

Alorica
04.2015 - 02.2016

Medical Customer Rep

HGS, Blue Cross Blue Shield
09.2014 - 04.2015

CVS

IGATE
02.2014 - 10.2014

Medical Receptionist

Adult and Children's foot
01.2013 - 12.2013

Bachelors - Health Administration

Southwest University

Associate of Applied Science - Billing And Coding

Southwest University

Medical record & Health information specialist - Diploma

Southwest Career College

High School Diploma -

Riverside High School

Graduated Medical Assistant - Certificate

Career Centers of El Paso
Jazmine Varela