JOANNA LEDEZMA
PHARR
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Insurance Verification Specialist
Thurmond Eye Associates
05.2021 - 06.2023
- Updated patient and insurance data and input changes into company computer system.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Liaised between physician, site of service and billing department to obtain appropriate documentation.
- Entered data in EMR database to record payer, authorization requirements and coverage limitations.
- Participated in training sessions on new software programs used for verification purposes.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Navigated through multiple online systems to obtain documentation.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Analyzed complex health plan contracts to determine benefit coverage levels for services rendered.
- Evaluated policies and procedures related to Insurance Verification activities.
- Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
HIM Specialist II
DHR Health
07.2013 - 04.2017
- Coordinated activities between various departments regarding access, storage, retrieval, transfer or destruction of healthcare records.
- Utilized computer applications such as word processing, spreadsheets and databases to maintain patient data.
- Maintained patient confidentiality in accordance with HIPAA regulations.
- Assisted in training new HIM staff members on proper document handling techniques.
- Assisted in the preparation of documents for filing and scanning into electronic health record systems.
- Retrieved, organized and scanned patient medical records into a digital database.
- Reviewed charts for accuracy prior to filing them into the correct location within the facility's document storage system.
Education
Some College (No Degree) - Health Information Technology
South Texas College
Mcallen, TX05.2013
High School Diploma -
Valley View High School
Pharr, TX05.2008
Skills
- Customer Service
- Data Entry and Review
- Communication and Interpersonal Skills
- Electronic Medical Records
- Insurance Coverage Verification
- Electronic Authorization Processing
- Medical Terminology
- Medicaid/Medicare Knowledge
- Insurance Verification Portals (TMHP, WELLMED, OPTUM, ETC)
- Eligibility Determination
- ICD-10 Coding
- Appeals
- Lesson Plan Implementation
- Special Education
- Classroom Organization
- Safety Awareness
- Positive Reinforcement
- Individualized Care
- Creative Problem Solving
- Activity Planning
Certification
- Certified Electronic Health Record Specialist (CEHRS)
- Certified Medical Billing Specialist
- Certified Substitute Teacher, Region One ESC - 2023
- BSL/ CPR Certified
Timeline
Insurance Verification Specialist
Thurmond Eye Associates
05.2021 - 06.2023
HIM Specialist II
DHR Health
07.2013 - 04.2017
Some College (No Degree) - Health Information Technology
South Texas College
High School Diploma -
Valley View High School
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