Luz Rosario Hernandez
San Gabriel,USA
Summary
Insurance professional with strong background in verifying insurance coverage and benefits. Skilled in navigating complex systems, resolving discrepancies, and ensuring accurate information. Seeking to expand expertise and explore new opportunities within the healthcare industry to enhance patient care and administrative performance.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Insurance Verification Specialist
Centene Corporation
09.2023 - Current
- Verify patient insurance eligibility, benefits, and coverage for medical services across multiple plans and providers.
- Process and track prior authorizations, ensuring timely approval for medications.
- Communicate with healthcare providers, insurance carriers, and patients to clarify benefit details and resolve coverage discrepancies.
- Maintain accurate and confidential documentation in compliance with HIPAA and company policies.
- Collaborate with billing and claims teams to support accurate claim submissions and minimize denials.
- Utilize systems such as Availity and internal portals to manage verification workflows efficiently.
Insurance Verification Specialist
VIP Family Practice
03.2021 - 09.2023
- Reviewed and verified patient insurance coverage to ensure accuracy before medical services were rendered.
- Resubmitted claims after edits or denials, reducing outstanding debt and improving reimbursement rates.
- Maintained working knowledge of medical terminology and payer requirements to streamline patient processing.
- Supported office operations by handling high-volume verification requests in a fast-paced environment.
Medical Receptionist
Eye Care Specialists of Florida
11.2020 - 02.2021
- Managed appointment scheduling to optimize provider availability and patient flow.
- Verified insurance and updated patient demographic and medical information.
- Delivered high-quality administrative support and excellent patient service.
Receptionist
The Terrace of Kissimmee
11.2019 - 11.2020
- Scheduled and confirmed appointments while maintaining client confidentiality.
- Handled multiple administrative duties under time-sensitive deadlines.
- Supported staff meetings by preparing materials and communicating updates to team members.
Education
Associate of Science - Nursing
Valencia College
Orlando, FLHigh School Diploma - undefined
Cypress Creek High School
Orlando, FLSkills
- Team collaboration and cross-department coordination
- Adaptability in fast-paced healthcare environment
- Accurate data entry and proficiency in Microsoft
- Strong communication and interpersonal skills
- Knowledge of medical terminology
- Problem-solving and analytical thinking
- Bilingual: English and Spanish
Certification
First Aid/CPR Certified
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Insurance Verification Specialist
Centene Corporation
09.2023 - Current
Insurance Verification Specialist
VIP Family Practice
03.2021 - 09.2023
Medical Receptionist
Eye Care Specialists of Florida
11.2020 - 02.2021
Receptionist
The Terrace of Kissimmee
11.2019 - 11.2020
High School Diploma - undefined
Cypress Creek High School
Associate of Science - Nursing
Valencia College
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