Jessica Herrera
Houston
Summary
Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows.
Professional collections specialist with strong focus on team collaboration and achieving results. Skilled in accounts receivable management, negotiation, and dispute resolution. Reliable, adaptable, and known for maintaining high standards and delivering impactful outcomes in dynamic environments. Excellent communication, problem-solving, and analytical abilities.
Overview
10
10
years of professional experience
Work History
Collections Specialist
Lymphedema Therapy Specialist
06.2024 - Current
- Maintained compliance with state and federal regulations during all collections activities, ensuring ethical business practices.
- Reduced delinquency rates by implementing effective collection strategies and maintaining consistent follow-up procedures.
- Developed customized reports for management, tracking key performance indicators related to collections efforts and results obtained.
- Contributed to a positive work environment by providing support, guidance, and expertise to junior team members as they navigated complex collections situations.
- Researched accounts and completed due diligence to resolve collection problems.
- Trained new team members on scripts, company services, and collection strategies.
- Collaborated with cross-functional teams to identify potential at-risk accounts and develop preventative measures.
- Supported company revenue growth by recovering outstanding debt through diligent monitoring and timely action on delinquent accounts.
Prior Authorization Representative
Odyssey Agency - MD Anderson
11.2023 - 03.2024
- Initiate prior authorization via web or verbal for various radiology and diagnostic procedures
- Follow up with pending authorizations and send medical records as needed
- Assist with maintaining and answering multi-line phone systems to assist patients and doctors regarding prior authorizations
- Maintain communication with patients and medical team regarding pending authorization for upcoming services.
Prior Authorization Coordinator
Modern Heart And Vascular
02.2023 - 11.2023
- Reviewed patient insurance coverage and eligibility for prior authorization requirements
- Communicated with insurance companies, healthcare providers, and patients to gather necessary information and documentation
- Submitted prior authorization requests and tracked the status of requests to ensure timely approval
- Submit prior authorization requests to insurance companies via phone, fax, or online portal
Pharmacy Customer Service Representative
Asamblea Aspn Pharmacies
07.2021 - 02.2023
- Assisted pharmacy customers with inquiries, medication counseling, and over-the-counter product recommendations
- Processed prescription orders and refills, including verifying insurance coverage and processing payments
- Prepared and dispensed medications under the supervision of a pharmacist
- Provided support to pharmacists and pharmacy technicians with administrative tasks and inventory management
Referral Appointment Clerk
Enhanced Revenue Solutions
07.2020 - 07.2021
- Schedule appointments for patients with specialist providers, ensuring timely access to care
- Verify insurance coverage and obtain authorization for referrals and appointments as needed
- Communicate with patients, providers, and insurance companies to gather necessary information and documentation
- Maintain accurate records of referral activities, including documentation of phone calls, emails, and correspondence
Prior Authorization Specialist
Healing Hearts Clinic
02.2019 - 07.2020
- Obtain prior authorizations from insurance companies for medical procedures, treatments, and medications as required
- Review patient medical records, provider orders, and insurance policies to determine authorization requirements
- Communicate with healthcare providers to gather necessary information and documentation for prior authorization submissions
- Follow up with insurance companies to track the status of prior authorization requests and ensure timely approval
Insurance Claims Specialist
Baylor St. Lukes Medical Group Woodlands North Houston Heart Center
09.2017 - 02.2019
- Verify insurance coverage, benefits, and eligibility for claims processing
- Communicate with insurance companies, healthcare providers, and policyholders to gather additional information and resolve claim-related issues
- Calculate claim payments and reimbursement amounts based on insurance policies, fee schedules, and contractual agreements
- Process insurance claims submitted by policyholders, healthcare providers, and third-party administrators
Insurance Verification Specialist
OBGYN Of Houston
01.2016 - 01.2017
- Verify insurance coverage and benefits for patients, including eligibility, deductibles, co-pays, and out-of-pocket expenses
- Obtain authorizations and pre-certifications for medical services and procedures as required by insurance plans
- Communicate with insurance companies, healthcare providers, and patients to gather necessary information and resolve insurance-related issues
- Process insurance claims and billing submissions accurately and efficiently, ensuring timely reimbursement
Education
Medical Billing and Coding
Fortis College
05.2012
Skills
- Type 50 WPM
- Proficiency in insurance verification processes and procedures
- Strong knowledge of medical terminology, insurance terminology, and billing codes (ICD-10, CPT, HCPCS)
- Familiarity with various insurance plans, including private insurance, Medicare, Medicaid, and managed care plans
- Experience in obtaining authorizations and pre-certifications for medical services and procedures
- Excellent communication and interpersonal skills
- Ability to multitask and prioritize tasks in a fast-paced healthcare environment
- Proficiency in using electronic health record (EHR) systems and insurance verification software
- Detail-oriented with a focus on accuracy and completeness
- Strong understanding of data entry processes, workflows, and quality control measures
- Proficiency in using data entry software and systems
- Credit and collections
Timeline
Collections Specialist
Lymphedema Therapy Specialist
06.2024 - Current
Prior Authorization Representative
Odyssey Agency - MD Anderson
11.2023 - 03.2024
Prior Authorization Coordinator
Modern Heart And Vascular
02.2023 - 11.2023
Pharmacy Customer Service Representative
Asamblea Aspn Pharmacies
07.2021 - 02.2023
Referral Appointment Clerk
Enhanced Revenue Solutions
07.2020 - 07.2021
Prior Authorization Specialist
Healing Hearts Clinic
02.2019 - 07.2020
Insurance Claims Specialist
Baylor St. Lukes Medical Group Woodlands North Houston Heart Center
09.2017 - 02.2019
Insurance Verification Specialist
OBGYN Of Houston
01.2016 - 01.2017
Medical Billing and Coding
Fortis College
Similar Profiles
Saragine JeudySaragine Jeudy
Revenue Cycle Supervisor at Lymphedema Therapy SpecialistsRevenue Cycle Supervisor at Lymphedema Therapy Specialists
Amber McgheeAmber Mcghee
Administrative Assistant at Lymphedema & Physical Therapy SpecialistsAdministrative Assistant at Lymphedema & Physical Therapy Specialists
Kate DufourKate Dufour
Student Technician at Dynamic Therapy SpecialistStudent Technician at Dynamic Therapy Specialist
Jennifer PickardJennifer Pickard
Purchasing and Operations Coordinator at Grace InstrumentPurchasing and Operations Coordinator at Grace Instrument
Anish RaghavanAnish Raghavan
Marketing Intern at TULU ltdMarketing Intern at TULU ltd