Lisette Mercedes
Lakeland,FL
Summary
A motivated medical professional seeking to gain knowledge and experience in the healthcare industry. Persistent leader eager to lead and grow organizations. Skilled in strategic planning, problem-solving, and communication with good understanding of business principles, project management and team leadership.
Overview
6
6
years of professional experience
Work History
Medical Billing and Collections Specialist
Central Florida ENT Associates
09.2022 - Current
- Preparing and submitting billing data and medical claims to insurance companies
- Reprocessing denial claims, submitting accurate documents to insurance for claim reconsideration
- Handle confidential information and abide by HIPAA laws and other medical policies
- Knowledge of codes such as CPT, ICD-10, and HCPCS
- Reviewing EOBs and submitting documents via fax or email to prove medical
- Patient calls regarding account balance or proof of eligibility
- Mailing Properly filled out HCFA-1500 claim forms to ensure claims and payments are processed quickly and accurately
- Billing and coding using EClinicals system
- Negotiated to collect balance in full
- Developed functioning system to collect account balances
Bilingual Customer Care Specialist
Humana
09.2018 - 05.2021
- Providing information on complex benefit questions, resolving issues, and educating providers
- Asked probing questions to determine service needs and accurately input information into computer systems
- Escalating unresolved and pending customer grievances and appeals
- Offered resolutions to de-escalate calls and solve customer issues
- Resolved customer inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks
- Documented customer correspondence in CRM to track requests, problems and solutions
- Follow appropriate procedures for claim reprocessing for Long-term care with providers
- Partnered with case managers to ensure members receive the quality care they deserve.
Security Officer/Field Training Officer
Chesley Brown International
01.2018 - 09.2019
- Followed established security and safety procedures and posted orders to include enforcement of company rules, policies and regulations
- Secured personnel and premises by inspecting buildings and patrolling property/ CCTV monitoring
- Trained all officers, supervisors and rovers.
Bilingual Customer Service Representative
NJ Healthcare Insurance
05.2017 - 12.2017
- Asked probing questions to determine service needs and accurately input information into electronic systems
- Upheld quality control policies and procedures to increase customer satisfaction
- Enrollments, Eligibility and billing
- Exceeded company productivity standards on consistent basis.
Education
High School Diploma -
Winter Haven High Winter Haven
Winter Haven, FL06.2017
Associate of Science - Healthcare Management
Ultimate Medical Academy (some College)
Tampa, FLCertificate: Clinical Dental Assisting -
The University of West Florida
Pensacola, FL05.2022
Skills
- Microsoft
- Database Management
- Collections Procedures
- Medical Billing
- System development
- Business Marketing
- Business Management
- HIPAA
- Medicare and Medicaid guidelines
- Claim adjusting
- Bilingual fluent in English and Spanish
CEO and Founder
Endzone Mobile Detailing LLC
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Your task is not to foresee the future, but to enable it.
Antoine de Saint-Exupéry
Timeline
Medical Billing and Collections Specialist
Central Florida ENT Associates
09.2022 - Current
Bilingual Customer Care Specialist
Humana
09.2018 - 05.2021
Security Officer/Field Training Officer
Chesley Brown International
01.2018 - 09.2019
Bilingual Customer Service Representative
NJ Healthcare Insurance
05.2017 - 12.2017
High School Diploma -
Winter Haven High Winter Haven
Associate of Science - Healthcare Management
Ultimate Medical Academy (some College)
Certificate: Clinical Dental Assisting -
The University of West Florida
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