Loriana Reyes
Donna ,TX
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Overview
16
16
years of professional experience
Work History
Insurances Verifier
DHR Health
11.2023 - Current
- Facilitated smooth transitions between health plans or policy changes for clients by coordinating updates across departments within the organization as needed.
- Reduced claim denials by diligently researching and resolving discrepancies in policy information.
- Expedited claim processing by promptly obtaining necessary pre-authorizations for medical procedures.
- Improved team efficiency by providing training and guidance to new employees on insurance verification processes.
- Collaborated with healthcare providers to obtain required patient information for accurate insurance verification.
- Provided exceptional customer service during interactions with clients, addressing concerns or questions promptly and professionally.
- Reviewed about 700 patient cases and insurance coverage information per week.
- Established contact with ordering physician's office to resolve any issues or to collect missing vital information.
- Enhanced client satisfaction by accurately verifying insurance coverage and processing claims in a timely manner.
- Supported billing department by verifying coverage details to ensure correct invoicing of clients and prompt payment from insurers.
- Managed high-volume caseloads efficiently while maintaining strict deadlines for completing verifications and processing claims.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Updated patient records with accurate, current insurance policy information.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- 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.
- Trained new staff on current, correct insurance verification procedures.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.`
- Coordinated authorizations through insurance and other medical specialists and documented details in patient charts.
- Streamlined the verification process with meticulous attention to detail, ensuring accurate data entry and documentation.
Medical Office Specialist
DHR Health
09.2022 - 11.2023
- Registered patients at check in and completed associated paperwork and scanned to patients chart.
- Scheduled patient at check out for future appointments with respective doctors' calendars and followed up with reminder phone calls.
- Provided prompt, polite and professional in-person and telephone customer service.
- Managed inventory and sells of bariatric vitamins .
- Collected co-payments and did daily deposits
- Scheduled patients for upcoming seminars and guided them through the process
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Prepared patient charts by gathering and organizing medical records ahead of appointments.
Prior Authorization Specialist
RGV Rehab Center
09.2016 - 08.2021
- Requested prior authorization for All of our Home Health and in Clinic Evaluations for Speech and Occupational Therapy.
- Requested prior authorizations for all of our Home Health and in Clinica therapy sessions .
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Organized and prepared documentation for peer to peer request from insurance
- Tracked referral submission during facilitation of prior authorization issuance.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
Insurance Customer Service Representative
Fred Loya Insurance Company
11.2008 - 10.2013
- Processed policy updates and changes accurately, ensuring client needs were met in a timely manner.
- Completed customer applications and updated records to reflect current information.
- Processed insurance policy cancellations and renewals quickly to meet call time targets.
- Set up customer payment plans to cover annual policies and renewals.
- Acted promptly to customer complaints, significantly reducing escalation rates.
- Processed and recorded new policies and claims.
- Modified, updated and processed existing policies.
- Verified client information by analyzing existing evidence on file.
- Collected premiums and issued accurate receipts.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
- Responded to customer requests for products, services, and company information.
- Checked documentation for accuracy and validity on updated systems.
Education
Certificate - Medical Office Specialist
STC
McAllen05.2005
Certificate - Medical Office Clerk
STC
Mcallen TX05.2005
High School Diploma -
EAGLE ACADEMY
Pharr Tx 05.2004
Skills
- Insurance Verification
- Coverage and Authorizations
- Analytical Thinking
- Prior authorization processing
- Accuracy and Precision
- Referral Coordination
- Time Management
- Multitasking
- Team Collaboration
Languages
Spanish
Full Professional
Timeline
Insurances Verifier
DHR Health
11.2023 - Current
Medical Office Specialist
DHR Health
09.2022 - 11.2023
Prior Authorization Specialist
RGV Rehab Center
09.2016 - 08.2021
Insurance Customer Service Representative
Fred Loya Insurance Company
11.2008 - 10.2013
Certificate - Medical Office Specialist
STC
Certificate - Medical Office Clerk
STC
High School Diploma -
EAGLE ACADEMY
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