Kaiya Callazo
Cypress
Summary
Achieved successful claims resolution by optimizing reimbursement review practices.,Enhanced benefit verification accuracy, resulting in improved patient satisfaction.,Streamlined healthcare operations to bolster patient account support effectiveness.
Overview
9
9
years of professional experience
Work History
Telehealth Care Navigator (Senior/Lead)
SynaptiCure Inc.
01.2023 - 01.2026
- Performed medical and pharmacy benefit verification by contacting insurance carriers and utilizing payer portals to confirm coverage, authorizations, deductibles, copayments, and reimbursement eligibility.
- Researched and resolved insurance coverage issues while collaborating with clinical, billing, and revenue cycle teams to ensure timely patient onboarding and uninterrupted care.
- Coordinated patient services by verifying reimbursement requirements, authorization status, levels of care, and insurance eligibility to reduce claim denials and bad debt risk.
- Communicated professionally with patients, payers, providers, and internal departments to resolve complex issues and ensure compliance with service standards.
Medical Biller & Coder / Revenue Cycle Specialist
Union Health Services
01.2020 - 01.2023
- Managed healthcare claims processing, claims research, denial resolution, appeals, and payer follow-ups while identifying root causes and implementing corrective actions.
- Reviewed unpaid claims, reimbursement activity, payer contracts, and payment variances to ensure payment accuracy and improve revenue cycle performance.
- Processed appeals, reconsiderations, and claim corrections while communicating with patients, providers, and payer representatives.
- Maintained AR documentation, analyzed claim trends, and ensured compliance with quality assurance and HIPAA guidelines.
Case Manager
Illinois Action for Children
01.2017 - 01.2020
- Managed intake, eligibility verification, and client documentation.
- Provided customer support and coordinated services in a high-volume environment.
- Maintained confidential records and accurate data entry.
Education
Associate of Science - Healthcare Administration
Ultimate Medical Academy
04.2025
Skills
Medical Billing
Revenue Cycle
Epic EMR
Data Entry
Claims Processing
Insurance Verification
Account Resolution
HIPAA Compliance
Patient confidentiality
Care coordination
Healthcare systems
Resource identification
Timeline
Telehealth Care Navigator (Senior/Lead)
SynaptiCure Inc.
01.2023 - 01.2026
Medical Biller & Coder / Revenue Cycle Specialist
Union Health Services
01.2020 - 01.2023
Case Manager
Illinois Action for Children
01.2017 - 01.2020
Associate of Science - Healthcare Administration
Ultimate Medical Academy