Luz Aviles
Choctaw,OK
Summary
Professional with strong background in registration management, adept at maintaining accurate records and providing exceptional customer service. Skilled in data entry, scheduling, and handling confidential information with integrity. Known for strong team collaboration, reliability, and adaptability to changing needs. Excels in fostering positive patient interactions and achieving results through efficient workflow management.
Knowledgeable administrative professional with expertise in medical records management, coding and data entry. Proven ability to review and document clinical data, ensuring accuracy and compliance. Well-versed in ICD-10, CPT and HCPCS coding systems.
Overview
22
22
years of professional experience
Work History
Registration Specialist
Tennova Healthcare
02.2024 - 04.2025
- Working at the ER registration checking in patient gathering all there personal information and putting in the system.
- Enhanced patient registration accuracy by diligently reviewing and verifying information on registration forms.
- Managed high-volume workloads while consistently meeting deadlines for processing registrations and updating records.
- Organized patient files, ensuring easy access for medical professionals while maintaining strict privacy standards.
- Implemented a feedback collection system from patients regarding their registration experience, leading to improvements in processes and services provided.
- Demonstrated excellent attention to detail when entering data into electronic health record systems, minimizing discrepancies between documents.
- Maintained a high level of confidentiality when handling sensitive patient data, adhering to HIPAA regulations.
- Provided exceptional customer service to patients during registration, addressing concerns and answering questions promptly.
Scheduling Specialist
Wellpath
07.2023 - 12.2023
- Schedule inmates front the county jail to the doctors appointment.
- Also get transportation from the jail to the facilities to the doctor office or hospital.
- Also send emails to set up the appointment.
Claims Processor
WellPath
09.2021 - 06.2023
- Processes claims from returned pended claims reports and those containing claim edits.
- Manually prices claims based on specific rates.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Audit peer's work for continued cross training and education.
- Follow-up on provider calls on status, explanation of payment, billing errors, and refund requests.
- Verified claim data correctness in preparation for processing.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
- Researched medical claims for validity to resolve discrepancies.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Maintained comprehensive database for enrollment data, claim submission and payment information.
- Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
Customer Service
Hollingsworth Oil Company
12.2019 - 09.2021
- Working on the register checking customer out when they purchased products and get gas at the store.
- Preparing breakfast for morning customer that comes to the store before they start their work shifts start.
- Counting the register for the next employee to start their shift.
- Counting lotto tickets for the end of the day.
- Running reports at the end of the shift.
Administration Registration Clerk
Western State Hospital
01.2017 - 09.2021
- Registers patients for admission services according to departmental policies and procedures in an accurate and timely manner.
- Offers assistance and provides direction to patient's information.
- Process the demographic information form for patients assuring completed and accurate data by maintaining at least a 90% accuracy rate tracked by departmental performance improvement plan.
- Complete necessary forms, requisitions and communicates current situations to the next shift for continuity of the department.
- Putting charts together for the nurse to interview patients and communicating with doctors to see the patients will be admitted into the hospital.
- Making copies for the visit and send them to the floor.
- Scanning patients documents into the computer via Meditech and Windows 10.
Customer Service Representative
Bucks Title Loans
01.2019 - 11.2019
- Makes calls to customer in the morning to let them know their payment is due or is past due.
- Help customer get title loan against their vehicle.
- Do appraisal on the vehicle and take pictures to send to corporate so they can run a credit check and approve the loan for the customer.
- We wait for the approval and cut the customer a check and give them the contract agreement and let them know where to cash the check at.
- Put the files together and file it away in the cabinet file.
Claims Processor
Cognizant Technology Solution
06.2016 - 04.2018
- Resolve complex claims using expertise and judgment.
- Manually enter rejected BancTec claims.
- Process claim that are pended accessing authorization from Maxmc.
- Manually price APG claims through Webstrat.
- Process claim according to policy provisions (Medicaid, PPO, and POS).
- Enter and process authorizations for Icore claims.
- Delegates paying the claim and that all information is correct.
- Encounter checking that the correct provider is billing for their service.
- Claim Processor checking all information of the provider and the patient is all correct to pay or deny the claim.
- Manually entering claim into Facets program processing claims.
- Process adjustments for claims.
- Processing claims on Facets.
- Verify the information for providers to pay claims.
- Electronic data interchange (EDI) is a claims processing computer-to-computer exchange of transaction information.
- Evicore was a program that the company used to get there EDI electronically.
- We as claims processor would check if correct or not if not we would fix it and send it back to the provider.
Claims Clerical Verification
Humana/Care plus
01.2008 - 05.2015
- Responsible for scanning claims into system.
- Verified accuracy of claims data scanned in the system.
- Adjudication research.
- Reload priority Batches and Medicare CMS 1500 via cross-training in the claims preloading.
- Collect and file batches reloaded and processed by Claims Examiners.
- Successfully work with others to ensure accuracy through typing speed, privacy and policy practice.
- Trained in CSC to diversify and Verifier.
- Processing Claims.
- Processing ERT Transportation.
- Getting the Authorization number for patient.
- Research on Certification and priority mail to see who and what provider isn't for and enter this information in the system for MCR.
- Also error's for verification on the CSC system.
- Researching in the Doctors notes and writing it up for the nurses to approve or deny the claim.
- Also if I have to create authorization I do.
- And after the nurse reviews it they send it back to the analyst and we close it out and send it to be completed.
- MCR MEDICAL CODE REVIEW -Check for authorization and assigned it to analysis.
- Also close out the claim.
- Claims Training, Learning how to read the ERT'S.
- PCA Training -Analyst -Training on EKG and CT Scans.
- PROVIDER SERVICES -Claims adjustments -Provider services and Claims Training.
- Claims Processing -Review records and write them up for the nurse and send to them for approve or denial.
Tax Preparer
Amscot Financial Corporation
01.2005 - 11.2010
- Check data input or verify totals on forms prepared by others to detect errors in data entry, and procedures.
- Interview clients to obtain additional information on taxable income and deductible expenses and allowance.
- Furnish taxpayer with sufficient information and advice in order to ensure correct tax form completion.
- Ensured complete client satisfaction through exceptional customer service.
Medical Records Coordinator/Pre-Cert Verification
Florida Orthopedic Institute
03.2003 - 02.2005
- Interfaced directly with diverse population of patients, responding to various inquiries and concerns.
- Communicated with physicians and medical support staff to determine the need for patient service.
- Obtained and processed patient's medical insurance information quickly and accurately.
- Maintained up to date computer based laboratory test results and patient information.
- Obtain medical transcriptions from physicians and collecting/processing patient's copayments.
Education
Associate of Arts -
Lincoln Technical Institute
Marietta, GAMedical Coding and Billing - Medical Technology
Erwin Technical Center
Tampa, FLHigh School Diploma - General Studies
Dr. Santiago Veve Calzada
Fajardo, PRSkills
- Medical coding/billing
- Medical terminology
- Medical records
- CPT coding
- Reliability
- HIPAA compliance
- Insurance and coding specialist
- Verbal and written communication
- Healthcare experience
- Registration data intake
- Experience with ICD-10
- Electronic health records EMR
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Registration Specialist
Tennova Healthcare
02.2024 - 04.2025
Scheduling Specialist
Wellpath
07.2023 - 12.2023
Claims Processor
WellPath
09.2021 - 06.2023
Customer Service
Hollingsworth Oil Company
12.2019 - 09.2021
Customer Service Representative
Bucks Title Loans
01.2019 - 11.2019
Administration Registration Clerk
Western State Hospital
01.2017 - 09.2021
Claims Processor
Cognizant Technology Solution
06.2016 - 04.2018
Claims Clerical Verification
Humana/Care plus
01.2008 - 05.2015
Tax Preparer
Amscot Financial Corporation
01.2005 - 11.2010
Medical Records Coordinator/Pre-Cert Verification
Florida Orthopedic Institute
03.2003 - 02.2005
Associate of Arts -
Lincoln Technical Institute
Medical Coding and Billing - Medical Technology
Erwin Technical Center
High School Diploma - General Studies
Dr. Santiago Veve Calzada
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