Lydia Aviles
San Antonio,United States
Summary
Highly skilled Reimbursement Specialist with 15 years of experience performing in health care facilities. Fully knowledgeable about insurance billing processes for medical center compensation of patient services. Certified Medical Reimbursement Specialist with strong customer service and interpersonal skills.
Overview
10
10
years of professional experience
Work History
MARKET ACCESS FIELD SPECIALIST
IMPEDIMED- REMOTE
04.2024 - Current
- Managed defined accounts in oncology within specific geographic regions, while fostering strong relationships with stakeholders for collaborative success
- Executed collaborative strategic plans and strengthening partnerships with internal and external stakeholders
- I facilitate efficient field reimbursement services and case assistance programs by ensuring comprehensive understanding of reimbursement processes
- I ensure smooth workflow by communicating complex health economic information to hospitals
- I streamline reimbursement processes by developing and implementing robust strategies
- Successfully managed a case workload of more than 25 accounts, consistently meeting all deadlines
- Assist sales with onboarding new clients
- Execute implementation plans, workflows with high customer satisfaction
- Provide monthly follow-up with client, site, & internal teams as to implementation status by tracking progress and Identifying and managing reimbursement risks, driving initiatives to enhance client satisfaction and retention
- Contributed to strategic decision-making by analyzing hospitals' reimbursement activities and financial environments as well as providing valuable insights into specifically bioimpedance spectroscopy utilization.
- Delivered high-quality results under pressure by adapting quickly to changing circumstances in the field environment.
- Fostered positive working relationships with clients through proactive communication and problem-solving initiatives.
CASE MANAGER
IMPEDIMED- REMOTE
01.2022 - Current
- Optimized workload distribution and performance management by assigning accounts to case managers
- Performance by reporting to management and providing insights and solutions
- Maintained database integrity by documenting case status and outcomes
- Analyzed key account data to identify trends and create action plans for improvement
- Guaranteed Forged strong relationships with clients and addressed concerns promptly by conducting regular meetings
- Cultivated collaborative work environment by supporting team with process questions and concerns
- Managed a workload of over 50-75 accounts, ensuring timely completion
- Recovered significant amounts for company and amplified business profitability by managing reimbursement processes and post-claim appeals
- Successfully overturned medical policies for payers and successfully overturned payer’s decisions to deny the use of medical equipment and the importance on medical necessity.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
Billing Coordinator Lead
Tots to teens pediatric dentistry
09.2021 - 01.2022
- Collaborate with finance and sales professionals to maintain accounts receivable
- Compile and process information such as prices, discounts, shipping rates etc
- Ensure customers are billed correctly for services offered
- Issue invoices and distribute them electronically or by mail
- Resolve disagreements between the company and its creditors
- Request payment of pending debts in a firm yet considerate manner
- Negotiate payment arrangements when needed
- Supervising 7 employees and assisting other professionals in the billing department.
FINANCIAL COUNSELOR
TEXAS ONCOLOGY
08.2019 - 09.2021
- Contacted insurance providers to obtain key information regarding patient benefits and to submit documentation for accounts
- Identified healthcare resources and programs for patients unable to meet financial obligations
- Created business plan and identified target customers by interacting on phone and in person, handling basic inquiries and providing quotes
- Liaised between patient, doctor, and insurance provider to smooth claims processes
- Negotiated settlements and payment plans
- Discussed financial and insurance options with patients
- Receive and post payments on accounts, process refunds, adjust customers invoices, and manage accounts
- Cross trained.
Patient Access Representative
Cape Fear Valley Medical Center
05.2016 - 05.2019
- Contributed to reduction of accounts receivables by adhering to predetermined policies and procedures to recover amounts due from patients
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks
- Attended weekly facility meetings to discuss logistical issues and obtain updated procedural and insurance-related instructions
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations
- Scheduled Diagnostic Procedures and managed over 75 phone calls daily.
Inpatient Coder
Deborah Heart and Lung Center
02.2014 - 02.2016
- Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided
- Interacted with physicians and other healthcare staff to ask questions regarding patient services
- Scanned and filed medical records in alphabetical order to maintain organized and up-to-date filing system
- Reviewed patient charts to better understand health histories, diagnoses, and treatments
- Resourcefully used various coding books, procedure manuals and on-line encoders
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes
- Implemented new coding procedures that reduced mistakes by 10% and simplified processes.
Education
Bachelor of Science - Healthcare Management
DeVry University
Downers Grove, IL06.2020
Skills
- Field Operations Specialist
- Site Inspections
- Quality Control Procedures
- Training and mentoring
- MS Office
- Decision-Making
- Problem Detection and Resolution
- Customer Service
Timeline
MARKET ACCESS FIELD SPECIALIST
IMPEDIMED- REMOTE
04.2024 - Current
CASE MANAGER
IMPEDIMED- REMOTE
01.2022 - Current
Billing Coordinator Lead
Tots to teens pediatric dentistry
09.2021 - 01.2022
FINANCIAL COUNSELOR
TEXAS ONCOLOGY
08.2019 - 09.2021
Patient Access Representative
Cape Fear Valley Medical Center
05.2016 - 05.2019
Inpatient Coder
Deborah Heart and Lung Center
02.2014 - 02.2016
Bachelor of Science - Healthcare Management
DeVry University
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