Loriana Reyes
Donna,TX
Summary
Detail-focused Insurance Verification Specialist recognized for high productivity and efficient task completion. Specialize in insurance policy verification, claim processing accuracy, and patient data confidentiality management. Excel in communication, problem-solving, and time management to ensure seamless operations within healthcare settings.
Overview
17
17
years of professional experience
Work History
Lead Insurance Verification Specialist
Doctors Hospital at Renaissance Health System
McAllen, Texas
08.2022 - Current
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Participated in audits and quality assurance activities related to insurance verification.
- Accessed third-party insurance databases to identify coverage of benefits.
- Conducted regular audits of patient accounts for accuracy of demographic data.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Navigated through multiple online systems to obtain documentation.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
- Updated patient and insurance data and input changes into company computer system.
- Educated patients on their insurance benefits and coverage limitations.
- Assisted in training new staff on insurance verification procedures and best practices.
- Updated patient accounts with insurance verification information to ensure accurate billing.
- Collaborated with healthcare providers to communicate insurance coverage and authorization details.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Responded to patient inquiries regarding insurance coverage and billing issues.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Verified patient insurance coverage, benefits, and eligibility for services across multiple insurance platforms.
- Managed multiple tasks and priorities in a high-volume, fast-paced environment.
- Scheduled and confirmed patient appointments and consultations.
Medical Records Specialist
RGV Rehab Center
McAllen, TX
12.2015 - 08.2022
- Purged inactive files and destroyed obsolete files following procedures.
- Provided respectful assistance to patients, staff members and insurance company representatives.
- Entered patient insurance, demographic and health information into software and confirmed records.
- Ensured that all required forms were completed accurately and completely prior to storage or release.
- Retrieved medical records upon request from healthcare professionals.
- Assigned patients to diagnosis-related groups using appropriate computer software.
- Participated in quality assurance activities to enhance the accuracy and privacy of patient records.
- Safeguarded patient records, managing data transfers in compliance with HIPAA standards and organizational regulations.
- Tracked and processed release of information requests.
- Verified record copies before handing each over to check for and remove unnecessary details.
- Safeguarded medical records to maintain patient confidentiality.
- Implemented updates and improvements to electronic health records systems as directed.
Customer Service Representative
Fred Loya Insurance
McAllen, TX
06.2008 - 10.2015
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Strengthened customer retention by offering discount options.
- Assisted customers with price checks, lifting heavy items and addressing other inquiries.
- Explained coverage options to potential policyholders, answering questions or concerns.
- Processed payments received from clients promptly according to established procedures.
- Assessed customer risk levels and recommended appropriate coverage options.
- Contacted underwriters and submitted forms to obtain binder coverage.
- Resolved customer complaints in a timely manner to maintain high satisfaction levels.
- Conducted meetings or phone calls with potential clients to present insurance policies and answer questions.
- Developed appropriate quotes based on risk information.
Education
High School Diploma -
Eagle Academy
Pharr, TX05-2004
Some College (No Degree) - Medical Technology
South Texas College
McAllen, TXSkills
- Insurance benefits verification
- Insurance plan verification
- Electronic authorization processing
Timeline
Lead Insurance Verification Specialist
Doctors Hospital at Renaissance Health System
08.2022 - Current
Medical Records Specialist
RGV Rehab Center
12.2015 - 08.2022
Customer Service Representative
Fred Loya Insurance
06.2008 - 10.2015
High School Diploma -
Eagle Academy
Some College (No Degree) - Medical Technology
South Texas College
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