KAREN LOPEZ
PHOENIX,AZ
Summary
Passionate Claims Associate with 10+ years working in a customer service environment, by helping others become successful. I have 1+ years working at a call center in the Express Claims Spanish Department. I also have 2+ years performing administrative work, interviews, and training new employees. In my most recent position as a PFS Representative offering experience researching and resolving issues related to billing, insurance and payment. Professionally answered questions, processed credit card payments and updated patient accounts. Effective at working closely with clients while maintaining upbeat attitude to obtain prompt payment and make payment arrangements.
Overview
12
12
years of professional experience
Work History
Case Management Coordinator
Abrazo West Campus
09.2023 - Current
- Collaborated with interdisciplinary teams to develop comprehensive care plans tailored to individual needs.
- Reviewed and developed intake and discharge planning strategies to encourage client engagement and retention.
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
- Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.
- Managed high caseloads, prioritizing tasks and maintaining organized records for timely follow-ups and accurate reporting.
- Developed strong relationships with healthcare providers to ensure patient-centered care was consistently provided.
- Reduced hospital readmissions by effectively implementing discharge planning strategies and ensuring appropriate post-acute care coordination.
- Monitored patient progress, regularly updating documentation and communicating relevant information to all pertinent stakeholders.
- Served as a liaison between patients, families, providers, and community resources to facilitate seamless transitions throughout the continuum of care.
PFS Representative
Banner Health
07.2022 - 09.2023
- Resolved disputes by contacting insurance companies on behalf of patients.
- Answered incoming patient phone calls and responded to voicemails to answer financial services questions.
- Established payment plans, allowing individuals to make monthly payments for services.
- Evaluated accounts for debt placement to determine outstanding debt and coordinate with debt vendors.
- Entered patient insurance information, confirmed eligibility and submitted claims for billing.
- Researched and identified patient billing issues to respond to patient questions and resolve.
- Posted discounts and adjustments to patient accounts.
- Coordinated with other departments such as coding and accounts receivable to resolve payment and billing issues.
- Fulfilled requests for EOBs, medical records and itemized statements.
- Updated patient data in MS4 database system.
- Assessed accounts to determine insurance coverage and self-pay options.
- Answered customer questions regarding account discrepancies or problems.
- Accepted and processed customer payments and applied toward account balances.
- Received payments and posted amounts to customer accounts.
- Recorded information about status of collection efforts.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
Auto Claims Associate
State Farm Auto Insurance
02.2019 - 07.2020
- Worked well independently and on a team to solve problems
- Served as a friendly, hardworking, and punctual employee
- Organized and prioritized work to complete assignments in a timely, efficient manner
- Utilized excellent deductive reasoning and logical thinking skills
- Remained punctual and professional at all times
- Utilized multilingual speaking abilities
- Worked in accordance with company values to achieve future goals
- Investigate new claims, and establish liability
- Ensure claims are processed correctly, and in timely manner so the customer can receive financial payout.
Health Aide
Western Valley Elementary
08.2018 - 10.2018
- Remained up-to-date with health and safety requirements and aimed to meet them at all times
- Handled correspondence, filing systems, and calendar plans
- Answered and screened incoming calls
- Followed directions well and took self-directed action when necessary
- Continually maintained a clean and sanitary environment for patients
- Communicated information and guidelines to patients and the families of patients.
Patient Transporter
Banner Estrella Medical Center
06.2018 - 07.2018
- Sterilized exam rooms, equipment, and tools prior to and after patient visits
- Provided high level patient care during heavy patient load periods needing additional personnel
- Transport patients for diagnostic exams, and to other floors in the hospital.
Back Office Supervisor
Clinica La Familia LLC
10.2016 - 06.2018
- Organized and implemented job roles and functions among employees
- Answered all customer queries with friendliness and expertise
- Managed complex customer requests from contact to completion
- Brought forth an in-depth understanding of processes and technologies used in the company
- Served as a dedicated Office Administrator in a fast-paced office
- Supervise 20+ employees
- Manage, and assign shifts for employees
- Train new employees.
Medical Assistant
Arizona Kidney Disease and Hypertension Centers
10.2015 - 10.2016
- Helped to maintain meticulous medical records, and made changes when necessary
- Documented medical histories, concerns, and changes in patient's condition
- Remained up-to-date on medical Best Practices and medical advancements
- Perform Urine tests, strep tests, and flu tests
- Collect blood, and send out blood for testing
- Translate
- Answer and handle multiple calls
- Send medication refills
- Take vital signs
- Educate patients on Kidney care
- Schedule follow up appointments and new patient appointments.
Front Office
Glendale Pediatrics
09.2014 - 10.2015
- Managed the office database, mail, payroll distribution, and the physical setting of the front office
- Managed telephone and email communication systems and maintained office supplies ordering office supplies with accuracy
- Managed front office traffic, answered phones, and routed calls and email correspondence
- Served as a dedicated Office Administrator in a fast-paced office
- Schedule new patient appointments and follow up appointments
- Proper insurance verification and process prior authorization for referrals and medications
- Collect payments and co-pays
- Knowledge of Insurance policies
- HIPPA and OSHA.
Referral Coordinator
Kids Kare Pediatrics LLC
09.2012 - 04.2014
- Identified and developed new referral sources
- Served as a coordinator at events, ensuring place settings were correct and all vendors delivered on time
- Process new patient referrals to different specialties and diagnostic places
- Request and follow through prior authorizations for medications and specialists.
Education
Some College (No Degree) - Health Science
Phoenix College Preparatory Academy
Medical Assisting Diploma - Medical Assistance
Carrington College - Phoenix
Phoenix, AZ05.2008
Diploma - General Studies
Career Success High School
Phoenix, AZ05.2006
Skills
- Microsoft Office
- Microsoft Excel
- Microsoft PowerPoint
- Microsoft Outlook
- Advanced Software System
- Knowledge
- Great Customer Service
- Call Center
- Administration
- Dependable and reliable
- AR Aging Reports
- Updating Customer Accounts
- Payment Solicitation
- Financial Documentation
- Analytical and Critical Thinking
- Administration and Management
- Payment Scheduling
- Credit Accounts
- Negotiation and Resolution
- Problem Investigation
- Conflict Resolution
- Damage Claims
- Delinquent Account Notification
- Attention to Detail
- Customer Relationship Management
- Persuasive Negotiation
- Problem Identification
- Credit and Collections
- Data Collection
- Discharge Documentation
- Problem-Solving
- Time Management
- Decision-Making
- Adaptability and Flexibility
Timeline
Case Management Coordinator
Abrazo West Campus
09.2023 - Current
PFS Representative
Banner Health
07.2022 - 09.2023
Auto Claims Associate
State Farm Auto Insurance
02.2019 - 07.2020
Health Aide
Western Valley Elementary
08.2018 - 10.2018
Patient Transporter
Banner Estrella Medical Center
06.2018 - 07.2018
Back Office Supervisor
Clinica La Familia LLC
10.2016 - 06.2018
Medical Assistant
Arizona Kidney Disease and Hypertension Centers
10.2015 - 10.2016
Front Office
Glendale Pediatrics
09.2014 - 10.2015
Referral Coordinator
Kids Kare Pediatrics LLC
09.2012 - 04.2014
Some College (No Degree) - Health Science
Phoenix College Preparatory Academy
Medical Assisting Diploma - Medical Assistance
Carrington College - Phoenix
Diploma - General Studies
Career Success High School
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