Years of experience in the Medical Field
Lisa Suarez
RCM Insurance Verifications and claims specialist
Ft. Lauderdale,FL
Summary
Senior RCM Specialist with expertise in process improvements and quality control. Proficient in insurance verification, authorizations and claim analysis, consistently driving team performance and ensuring timely resolutions. Committed to enhancing patient care and optimizing operational workflows.
Overview
26
26
Work History
Senior RCM Specialist
Ventre Medical Associates, LLC.
Hollywood , FL
02.2022 - 05.2025
- Verified insurance coverage and benefits and input explanation of said benefits into patients charts for appointments scheduled next day.
- Met daily deadlines.
- Promoted after 6 months to a Senior VOB Representative.
- Assisted in Training new hires and created forms and documents for Training purposes.
- Perform Quality Control on over 20 provider accounts with over 25 patients each, documented errors and reported to upper management with said findings.
- Work on the fly and respond within minutes to request for copays, billing issues and patient benefits checks for front desk staff via teams messenger App.
- Attend meetings with outsource company providing VOB reps and trained and reviewed their errors and explained our process and our policies.
- Coordinated with other departments to ensure efficient workflow processes.
- Provided technical support for users experiencing difficulties with software applications.
- Created training materials for new hires on the company's procedures and policies.
- Generated reports to track performance metrics of team members.
- Conducted regular meetings with staff to review progress and address any concerns.
- Implemented process improvements to increase efficiency and reduce costs.
- Created plans to propose solutions to problems related to efficiency, costs or profits.
- Processed prior authorization requests in accordance with departmental guidelines.
- Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
- Performed data entry into various computer systems including but not limited to EMRs and CRMs.
- Researched patient eligibility, coverage information, and benefit levels.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
- Analyzed denials received from third party payers to identify trends in denials and develop proactive measures for resolution.
- Reviewed authorization requests for accuracy and completeness.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
- Verified insurance authorizations with payers via telephone or web-based systems.
Patient Care Coordinator
Premier Total Healthcare
12.2015 - 09.2021
- Greet Patients, Answer phones, schedule appointments, check Insurance Coverage and benefits, contact new patient referrals, set up appointments for MD and PT, enter patient demographics, collect copays, marketing, create Marketing Flyers, post on social media, assist my boss by reminding him of all his business and personal appointments.
- Called the doctor's office for my boss to schedule his personal appointments.
- Called attorneys' offices new to our business and set up Marketing Lunch Meetings for introductions.
Education
High School Diploma -
Miramar High School
01.2000
Skills
- Microsoft Word
- Excel
- Publisher
- SharePoint
- Outlook
- Prior authorizations
- Patient eligibility
- Quality control
- Process improvement
- Insurance verification
- Performance tracking
- Claims investigation
- Billing reconciliation
- Verbal and written communication
- Claims processing
- Payments posting
- Medical terminology
- Claims trend analysis
- Multitasking capacity
References
References available upon request.
Timeline
Senior RCM Specialist
Ventre Medical Associates, LLC.
02.2022 - 05.2025
Patient Care Coordinator
Premier Total Healthcare
12.2015 - 09.2021
High School Diploma -
Miramar High School
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