Joddie Mendez
Elmwood Park ,NJ
Summary
Experienced Insurance Verification and Authorization Specialist with a strong background in medical billing, appeals, and prior authorizations. Skilled in verifying benefits, obtaining authorizations, and communicating effectively with insurance providers to ensure timely patient care. Proven ability to work in high-volume environments with accuracy and attention to detail. I want to maintain my career in the medical field where my knowledge is both valuable and appreciated, also seeking a position to maximize my abilities in a challenging high paced environment; one that utilizes my analytical abilities, potential, experience and education to create a beneficial and long lasting workplace.
Experienced with managing complex authorization processes, ensuring compliance and efficiency. Utilizes strong problem-solving abilities to streamline workflows and enhance patient satisfaction. Knowledge of industry standards and team collaboration drives successful authorization management.
Professional in healthcare industry with strong background in managing authorizations and ensuring compliance. Skilled in navigating complex systems, problem-solving, and maintaining accurate records. Known for effective collaboration, adaptability, and delivering results in fast-paced environments. Reliable team player with expertise in healthcare regulations, communication, and customer service.
Overview
16
16
years of professional experience
Work History
Authorization Specialist
Basic Home Infusion
Wayne, NJ
10.2024 - Current
- Verify patient insurance benefits, eligibility, and coverage
- Communicate daily with insurance companies and providers
- Submit and follow up on prior authorizations
- Obtain OON authorizations, gap exceptions, and agreements
- Review clinical documentation for medical necessity
- Resolve denials and manage appeals
- Maintain accurate documentation and collaborate with teams
- Reviewed and processed patient authorization requests for home infusion therapies.
- Collaborated with healthcare providers to ensure compliance and timely approval of services.
Medical Appeals Representative
Precision Billing & Consulting Services
Hackensack, NJ
01.2022 - 11.2023
- Handled appeals and grievance cases
- Conducted case reviews and gathered documentation
- Adeptly managed a multi-line phone system and pleasantly greeted all insurance companies.
- Maintained strict patient and physician confidentiality.
- Reviewed and solved account and billing discrepancies.
- Assessed accounts for payment status and reached out to customers.
- Rendered decision for non-clinical complaints using sound, fact-based decision making.
- Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Carried out day-day-day duties accurately and efficiently.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Performed duties in accordance with applicable standards, policies and regulatory guidelines to promote safe working environment.
Billing Representative Senior Lead
BioReference Laboratories
Elmwood Park, NJ
04.2010 - 02.2021
- Verified eligibility and claims status
- Resolved billing issues and discrepancies
- Communicated with patients and insurance companies
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Researched questions and concerns from providers and provided detailed responses.
- Managed billing inquiries and resolved discrepancies for high-volume accounts, ensuring customer satisfaction.
- Processed insurance claims efficiently, verifying accuracy and compliance with industry regulations.
Education
CMA -
HoHoKus Hackensack School of Business & Medical Sciences
01-2008
Skills
- Insurance verification & benefits interpretation
- Prior authorization processing (commercial, Medicare, Medicaid)
- Out-of-network (OON) authorization & gap exception requests
- Appeals & denial management
- Strong payer communication
- EMR/EHR systems
- Claims and authorization tracking
- Medical terminology
- Multitasking in fast-paced environments
- Attention to detail and problem solving
- Claims management
- Medical terminology expertise
- Insurance verification
- Data entry proficiency
Timeline
Authorization Specialist
Basic Home Infusion
10.2024 - Current
Medical Appeals Representative
Precision Billing & Consulting Services
01.2022 - 11.2023
Billing Representative Senior Lead
BioReference Laboratories
04.2010 - 02.2021
CMA -
HoHoKus Hackensack School of Business & Medical Sciences