Leanora Silvano
Palm Springs,CA
Summary
Experienced as a patient advocate/ customer service with 20+ years of experience in the medical field. Excellent reputation for resolving problems and improving customer satisfaction. Dedicated and professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
25
25
years of professional experience
1
1
Certificate
Work History
Eligibility & Enrollment Services Patient Advocate
Conifer Healthcare Solutions
07.2011 - Current
- Communicate with people from various cultures and backgrounds on application process. As well as Desert Regional Medical Center ED staffs.
- Documente all communication with applicants and input information into system using Advocatia, ACE and PBAR.
- Follow guidelines when reviewing applicant data to determine eligibility for financial assistance, Medi-Cal and ACA(Affordable Care Act) insurance.
- Schedule appointments with applicants to gather information and explain benefits processes.
- Interview applicants and explained scope of different available benefits.
- Review applications for different aid programs and determine which qualification criteria for individuals.
- Manage processing of financial assistance, Medi-Cal and ACA(Coveredca).
- Input all gathered information and researched data on applicants into computer system using Advocatia, ACE and PBAR.
- Update/add the patient's insurance into the system.
- Train new employees in the department.
Insurance Collector
Tenet Healthcare Corporation
04.2002 - 08.2004
- Entered client details and notes into system for interdepartmental access and review.
- Listened to customers and negotiated solutions that met creditor and debtor needs.
- Located customers with overdue accounts and solicited payment in compliance with fair debt collection practices.
- Paid or denied medical claims based upon established claims processing criteria.
- Responded to correspondence from insurance companies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis by calling or written appeal for incorrect,deferred or denied claim by the insurance.
Charge Entry Analyst/Cancer Center Collector
Cancer Comprehensive Center
04.2002 - 08.2004
- Responded to customer concerns and questions on daily basis.
- Executed billing tasks and recorded information in company databases.
- Used data entry skills to accurately document and input statements.
- Handled account payments and provided information regarding outstanding balances.
- Monitored outstanding invoices and performed collections duties.
- Performed transferring charges from the DRMC accounts to CCC accounts.
- Monitored and verified the accounts if charges were properly transferred to the designated accounts.
- Monitored and verified if payments were in accordance to the contracts.
- Submitted a written appeal on accounts that were deferred or denied of payments.
Medical Claims Processor
Empire Physicians Medical Group
02.2000 - 04.2002
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Responded to correspondence from insurance companies and hospitals.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Reviewed provider coding information to report services and verify correctness.
- Evaluated accuracy and quality of data entered into EZ cap system.
- Checked documentation for accuracy and validity on updated systems.
- Verified client information by analyzing existing evidence on file.
- Generated, posted and attached information to claim files.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Modified, updated and processed existing policies.
- Calculated adjustments, premiums, and refunds.
- Communicated verification and authorization status updates with authorization department to facilitate decision-making for patient admissions and insurance coverage.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Coordinated with contracting department to resolve payer issues.
- Determined appropriateness of payers to protect organization and minimize risk.
- Notified insurance agents and accounting departments of policy cancellations and changes.
Authorization Coordinator
Desert Medical Group/Desert Oasis Health Care
07.1993 - 04.2000
- Submitted for prior authorization with required documentation to appropriate procedures or visits to the medical specialists.
- Reviewed documentation for accuracy and assessment of necessity prior to Medical Director's approval.
- Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.
- Maintained consistent follow-up on status of prior authorization requests.
- Maintained files and controlled records to show correspondence activities.
- Communicated with executives about consistent customer issues.
- Reviewed authorizations from payer to determine approved or denied items.
- Read incoming correspondence to ascertain nature of writers' concerns and to determine disposition of correspondence.
- Edited letters and written material for correspondence.
- Completed form letters in response to requests or problems identified by correspondence.
- Presented clear and concise explanations of governing rules and regulations.
- 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.
Education
Preparatory To Nursing -
College of The Desert
43500 Monterey Ave, Palm Desert, CA 9226008.2011
Bachelor of Science - Biology
Far Eastern University
Manila, Philippines05.1993
High School Diploma -
St Francis De Assisi High School
Malabon, Philippines06.1989
Skills
- Patient Information Management
- Reviewing Patient Information
- Quality Assurance
- Benefits Verifications
- Medicare Knowledge
- Medi-Cal Knowledge
- Verbal and Written Communication
- Financial Counseling
- Reliability and Dedication
- Bilingual in Filipino, Spanish and English
- Organization and Time Management
- Familiarity of EPO,PPO,HMO insurance
- Claims Handling and Coverage Verification
Certification
- Certified CEC(Certified Enrollment Counserlor) California's Health Benefit Exchange, Conifer Health - Current- November 2023
Timeline
Eligibility & Enrollment Services Patient Advocate
Conifer Healthcare Solutions
07.2011 - Current
Insurance Collector
Tenet Healthcare Corporation
04.2002 - 08.2004
Charge Entry Analyst/Cancer Center Collector
Cancer Comprehensive Center
04.2002 - 08.2004
Medical Claims Processor
Empire Physicians Medical Group
02.2000 - 04.2002
Authorization Coordinator
Desert Medical Group/Desert Oasis Health Care
07.1993 - 04.2000
Preparatory To Nursing -
College of The Desert
Bachelor of Science - Biology
Far Eastern University
High School Diploma -
St Francis De Assisi High School
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