Jessica Lopez
Van Nuys,California
Summary
Highly motivated professional with experience in administration and customer service, seeking to contribute to the success of an organization and further develop personal and career-based goals.
Overview
10
10
years of professional experience
Work History
Eligibility Representative
HMCR SOLUTIONS
2023.12 - Current
- Verify Eligibility for HMO's, MEDICAL,MEDICARE and PPOs.
- Reduced errors in eligibility determinations through meticulous attention to detail and rigorous quality control measures.
- Correct denied claims and re-bill to Insurances
- Outbound calls to providers for Eligibility Information
Patient Benefits Coordinator
Southern California Orthopedic Institute
2019.11 - 2023.11
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Resolved issues and inquiries from plan participants regarding health and Medical Benefits and deductions through telephone, email, and in-person interactions.
- Submit referrals to private insurances for office visits and surgeries.
- Process authorization requests that are pended or reprocess approved or denied authorizations.
Eligibility Coordinator
Quest Diagnostics
2018.05 - 2019.05
- Update and maintain correct patients eligibility corresponding to date of service.
- Outbound calls to providers and facilities, verifying billing and eligibility information
- Bill and re-bill denied claims to proper Health insurances and Medicare.
- Resolving any errors on patients information and evaluating doctors notes for billing.
ACA Eligibility Representative 1
Health Net-Centene
2015.03 - 2018.01
- Resolved discrepancies with member applications to verify eligibility.
- Managed approximately 20 incoming calls per day, Assisting members with accurate eligibility and enrollment information.
- Processed enrollments, plan changes and cancel transactions.
- Maintain accurate eligibility records for individuals enrolled through the affordable/American care Act.
Education
No Degree -
Pierce College
Woodland Hills Skills
- Microsoft Office
- Word
- Excel
- Microsoft Outlook
- Typing 45 WPM
- Bilingual English (Spanish)
- Reliable
- Responsible
- Little to no supervision needed
- Ability to multitask and handle fast paced work
- Ability to work under pressure and meet deadlines
- Strong organizational skills
- Team player
References
Available Upon Request
Timeline
Eligibility Representative
HMCR SOLUTIONS
2023.12 - Current
Patient Benefits Coordinator
Southern California Orthopedic Institute
2019.11 - 2023.11
Eligibility Coordinator
Quest Diagnostics
2018.05 - 2019.05
ACA Eligibility Representative 1
Health Net-Centene
2015.03 - 2018.01
No Degree -
Pierce College