Marisela Frampton
Henderson,NV
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Seeking to maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
20
20
years of professional experience
Work History
Patient Service Representative
HealthCare Partners Medical Group
Las Vegas, Nevada
12.2018 - 12.2023
- Improved patient satisfaction by providing exceptional customer service during check-in and check-out processes.
- Enhanced office efficiency by managing multi-line phone systems and promptly directing calls to appropriate personnel.
- Streamlined appointment scheduling for increased patient convenience and reduced wait times.
- Maintained a well-organized front desk, contributing to a welcoming environment for patients and visitors.
- Assisted with insurance verification tasks, ensuring accurate billing and timely reimbursement for services rendered.
- Collaborated with clinical staff to coordinate care plans, resulting in improved patient outcomes.
- Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers.
- Facilitated patient registration by accurately entering demographic and insurance information into electronic health record systems.
- Contributed to the resolution of billing disputes by working closely with insurance companies and patients to clarify charges and payment expectations.
- Provided compassionate support for patients facing financial challenges, assisting them in navigating available resources and payment options.
- Served as a reliable source of information for patients regarding appointment scheduling, insurance coverage inquiries, and general office policies.
- Reduced no-show rates through consistent appointment reminder calls, leading to improved clinic productivity.
- Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
- Actively participated in team meetings focused on improving workflows and enhancing overall practice performance.
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
- Verified insurance eligibility and coverage for patients.
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Entered patient demographic and insurance data into electronic medical record system.
- Used Touch Works to schedule appointments.
- Resolved customer complaints using established follow-up procedures.
- Processed incoming referral requests for medical services and submitted them to the appropriate insurance companies for authorization.
- Assisted patients in understanding their insurance coverage and answered questions about referrals, authorizations, and other related issues.
- Collaborated with team members to ensure the accuracy of referral data entered into the system.
- Maintained a database of referral information and tracked referrals received and sent out.
- Screened incoming requests for referrals, verifying accuracy of information and eligibility requirements.
- Reviewed patient records and medical history prior to making any recommendations or decisions related to referral requests.
Medical Records and Health Information Technician
Intermountain Healthcare
12.2018 - 12.2023
- Enhanced patient care by accurately organizing and maintaining medical records and health information.
- Streamlined record-keeping processes for increased efficiency in retrieving crucial patient information.
- Assisted healthcare providers with timely access to accurate medical records, contributing to better patient outcomes.
- Ensured compliance with HIPAA regulations through diligent management of confidential patient data.
- Reduced errors in coding diagnoses and procedures by meticulously reviewing medical records for accuracy.
- Conducted regular audits of medical records to identify discrepancies and areas for improvement in documentation practices.
- Trained fellow technicians on best practices for managing health information, fostering a high-performance team environment.
- Managed the release of information process, safeguarding sensitive patient data while adhering to legal requirements.
- Kept up-to-date with industry advancements by attending professional development workshops and conferences regularly.
- Acted as a liaison between departments, coordinating efforts to achieve efficient interdepartmental communication concerning health information management.
- Monitored changes in regulations and guidelines affecting medical records management, adjusting departmental policies accordingly.
- Maintained confidentiality of all medical records and sensitive information to comply with HIPAA regulations.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Supported medical staff by providing organized and accurate medical records.
- Assisted in preparation of medical records to release to other medical facilities requesting for patient history and information.
- Uploaded physician progress notes, history, and physicals into electronic medical records.
- Scanned medical records in digital format for easy retrieval and accessibility.
- Transcribed and entered patient medical information into electronic medical records systems.
- Reviewed and processed electronic health record requests from insurance companies, attorneys and other third-party entities.
- Maintained detailed records of all patient referrals, including dates of submission, status updates, and any additional information required by insurance providers.
- Aided clinical team to support administrative needs for clinical referrals.
- Collected required signatures to initiate referral process.
Medical Claims Examiner
Intermountain Healthcare
12.2018 - 12.2023
- Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
- Streamlined workflow for faster resolution of medical claims through effective prioritization and organization.
- Reduced errors in claim submissions by meticulously reviewing patient information and verifying insurance eligibility.
- Collaborated with healthcare providers to obtain necessary medical records, ensuring timely and accurate claim adjudication.
- Identified fraudulent activities by analyzing patterns, trends, and discrepancies in medical claims data.
- Maintained compliance with industry regulations and company policies while evaluating medical claims for accuracy and legitimacy.
- Provided exceptional customer service, addressing concerns from policyholders and answering inquiries related to their claims status.
- Increased productivity by implementing efficient strategies for handling high volumes of medical claims daily.
- Kept up-to-date on current industry practices, attending workshops and training sessions to continuously improve professional skills.
- Evaluated the necessity of additional treatments or procedures based on established criteria, protecting patients from unnecessary interventions or costs.
- Supported team members during periods of high workload, providing guidance on challenging cases or offering assistance when needed.
- . Fostered positive relationships with key stakeholders, collaborating effectively to resolve disputes or discrepancies in a timely manner.
- Assisted in the training and onboarding of new team members, sharing knowledge and best practices to ensure their success.
- Continuously sought opportunities for process improvement, contributing innovative ideas to enhance overall departmental efficiency and effectiveness.
- Paid or denied medical claims based upon established claims processing criteria.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Monitored and updated claims status in claims processing system.
- Reviewed provider coding information to report services and verify correctness.
- Identified and resolved discrepancies between patient information and claims data.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Followed up on denied claims to verify timely patient payment and resolution.
- Researched and resolved complex medical claims issues to support timely processing.
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Maintained claims data in EHR and IDX systems.
- Verified insurance coverage and eligibility of patients for services rendered.
- Investigated discrepancies in claims data, reconciled errors, and corrected inaccuracies as needed.
- Provided support and information to patients regarding their referrals.
- Communicated effectively with insurance companies regarding authorization for referrals.
Billing Specialist & Receptionist
Amerisent Insurance
12.2017 - 12.2018
- Improved billing accuracy by implementing a streamlined invoicing process.
- Enhanced customer satisfaction with timely and accurate invoice generation.
- Reduced errors in financial records by conducting regular audits of billed accounts.
- Collaborated with the collections team to recover overdue payments from clients, maintaining cash flow and minimizing writeoffs.
- Maximized revenue potential by identifying and resolving under-billed accounts.
- Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
- Strengthened client relationships through effective communication regarding billing issues and concerns.
- Simplified complex billing procedures for clients by creating easy-to-understand documentation and training materials.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
- Developed customized reports for management, providing valuable insights into trends, anomalies, and opportunities for improvement in the billing process.
- Ensured accurate policy administration by diligently reviewing and updating client information, reducing errors in coverage.
- Improved overall efficiency of the agency by implementing streamlined processes for managing new and existing clients.
- Enhanced customer experience by promptly addressing inquiries and resolving issues related to auto insurance policies.
- Developed strong relationships with clients, fostering trust and loyalty while promoting long-term business growth.
- Collaborated with underwriters to ensure accurate risk evaluation, optimizing premium rates for both company profitability and client affordability.
- Maintained up-to-date knowledge of industry trends and regulations, ensuring compliance and effective communication of changes to clients.
- Leveraged professional network to generate referrals, driving new business opportunities for the agency.
- Provided exceptional service through timely follow-ups with clients, keeping them informed throughout the claims process.
- Streamlined workflow by effectively prioritizing tasks according to urgency and impact on customer outcomes.
- Facilitated smooth policy renewals by proactively identifying and addressing potential issues before they escalated, ensuring client satisfaction.
- Registered customer information on database to enable tracking history and maintain accurate records.
- Developed comprehensive marketing plans to promote insurance products to potential clients.
- Educated clients on insurance policies and procedures.
- Finalized sales and collected necessary deposits.
- Generated leads through cold-calling, networking and other outreach methods.
- Conducted research and identified market trends to develop better strategies for sales.
- Researched and identified potential new markets.
- Expanded agency''s market share through successful client acquisition and retention strategies.
Makeup Artist / Product Specialist/Counter Manager
MAC Cosmetics
11.2013 - 05.2017
- Increased customer satisfaction by providing exceptional service and product knowledge.
- Achieved sales goals through effective communication and demonstration of products.
- Managed inventory to ensure adequate stock levels and timely replenishment.
- Developed strong relationships with clients, resulting in repeat business and referrals.
- Collaborated with team members to improve overall store performance and achieve targets.
- Conducted regular staff training sessions for product knowledge and sales techniques.
- Resolved customer complaints professionally, ensuring a positive outcome for all parties involved.
- Implemented visual merchandising strategies to attract customers and promote featured products.
- Analyzed sales trends to make informed decisions on promotional activities and product offerings.
- Maintained cleanliness and organization of counter area, adhering to company standards at all times.
- Assisted in the recruitment, training, and supervision of new employees, contributing to team success.
- Promoted brand loyalty by creating personalized experiences for each customer during their visit.
- Prepared daily reports on sales, inventory levels, and other key performance indicators for management review.
- Participated in special events or promotions as needed to boost sales and increase brand visibility in-store or online platforms.
- Established open lines of communication between counter staff and management to facilitate smooth operations.
- Optimized counter space utilization by reorganizing displays based on product popularity or seasonal trends.
- Handled cash transactions accurately, balancing registers at the end of each shift without discrepancies.
- Monitored competitor activity within the market segment to stay ahead with innovative strategies.
- Conducted monthly audits of stock levels for accurate record-keeping purposes.
- Collaborated closely with vendors for timely delivery of orders while maintaining a healthy professional relationship.
- Recommended, selected and helped locate or obtain specific merchandise based on customer needs and desires.
- Performed all stock keeping processes and assisted in replenishing all items as per company policy.
- Sold merchandise through effective customer service techniques and professional selling skills to reach productivity goals.
- Facilitated strategies to present and sell merchandise through regular product demonstrations.
- Budgeted, audited and balanced cash handlings to secure cash drawer.
- Communicated regularly with vendors, planners, distributors and buyers regarding stock needs, customer preferences and special events.
- Prepared and implemented effective calendar for product line on monthly basis and managed all promotions.
- Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
- Established team priorities, maintained schedules and monitored performance.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
- Defined clear targets and objectives and communicated to other team members.
- Set aggressive targets for employees to drive company success and strengthen motivation.
- Planned, created, tested and deployed system life cycle methodology to produce high quality systems to meet and exceed customer expectations.
Assistant Manager
Wine And Canvas
02.2014 - 03.2015
- Improved customer satisfaction by addressing and resolving complaints promptly.
- Streamlined store operations for increased efficiency, implementing new processes and procedures.
- Developed strong working relationships with staff, fostering a positive work environment.
- Increased sales through effective merchandising strategies and targeted promotions.
- Managed inventory levels to minimize stockouts while reducing overhead costs.
- Conducted employee performance evaluations, providing constructive feedback for growth and development.
- Collaborated with the management team to develop strategic plans for business growth and improvement.
- Boosted employee morale by recognizing outstanding performance and celebrating team accomplishments.
- Maintained a clean, safe, and organized store environment to enhance the customer experience.
- Assisted in recruiting, interviewing, hiring, and onboarding of new employees to maintain adequate staffing levels.
- Scheduled staff shifts to ensure proper coverage during peak shopping hours without exceeding labor budgets.
- Coordinated with vendors to ensure timely delivery of products and resolve any supply chain issues.
- Facilitated clear communication between employees and upper management through regular meetings and updates.
- Enforced company policies consistently while handling disciplinary actions when necessary with fairness and respect.
- Promoted teamwork within the workplace by encouraging collaboration among staff members on various projectstasks.
- Ensured compliance with all safety regulations by conducting regular inspections of equipment/operations within the store.
- Supervised day-to-day operations to meet performance, quality and service expectations.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Offered hands-on assistance to customers, assessing needs, and maintaining current knowledge of consumer preferences.
- Generated repeat business through exceptional customer service and responded to customer concerns with friendly and knowledgeable service.
- Helped with planning schedules and delegating assignments to meet coverage and service demands.
- Developed strategy to increase sales and drive profits.
- Made hiring recommendations to increase company's productivity and profitability with quality workers.
- Increased employee performance and job satisfaction to strengthen retention and engagement.
- Monitored security to protect employees, customers and property.
- Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Reduced waste and pursued revenue development strategies to keep department aligned with sales and profit targets.
- Controlled resources and assets for department activities to comply with industry standards and government regulations.
Instructional Assistant
Clark County School District, CCSD
01.2007 - 10.2009
- Enhanced student comprehension by utilizing multimedia resources and interactive activities in lesson plans.
- Assisted teachers in developing differentiated instructional strategies, resulting in improved student outcomes.
- Provided one-on-one support to students with special needs, enabling them to achieve academic success.
- Implemented behavior management techniques to maintain a positive and focused learning environment.
- Supported the integration of technology into the classroom, increasing student engagement and facilitating individualized learning experiences.
- Monitored student progress through ongoing assessments, adjusting instruction as needed for optimal growth.
- Participated in professional development opportunities, staying current on best practices in education and instructional support.
- Assisted educators in planning and executing field trips that reinforced curriculum content while providing hands-on learning experiences for students.
- Managed classroom materials inventory, ensuring necessary supplies were available for daily lessons and activities.
- Promoted a culture of respect and inclusion within the classroom, fostering positive relationships among students from diverse backgrounds.
- Facilitated small group instruction sessions based on specific skill sets or subject matter, boosting overall student achievement levels.
- Prepared instructional materials such as worksheets, visuals aids, or manipulatives according to teacher directives for effective lesson execution.
- Supervised students during non-instructional times such as lunch breaks or recess periods, maintaining safety standards at all times.
- Assisted in collecting and analyzing data from various assessments to identify trends that informed future instruction planning.
- Provided feedback on student work samples allowing teachers to better understand strengths and areas for improvement.
- Contributed to a positive and collaborative school culture by actively participating in staff meetings, committees, and professional learning communities.
- Provided support to help students with special needs learn and grow.
- Collaborated with other instructional assistants and teachers to provide comprehensive support to students and deliver instruction aligned with curriculum standards.
- Supported student learning objectives through personalized and small group assistance.
- Monitored student progress to identify areas requiring extra support and implement action plans to meet needs.
- Maintained safety and security by overseeing students in recess environments.
- Assisted with classroom technology to prepare students with skills needed to succeed in technology-rich world.
- Supervised extracurricular activities to provide students with opportunities to explore interests and develop new skills.
- Supported English Language Learners (ELLs) to deliver high-quality education for students learning English.
- Copied, organized and distributed classroom assignments or other paperwork.
- Mentored and tutored individual students needing additional help.
- Encouraged small groups to discuss topics and explore concepts through hands-on activities.
- Monitored student behavior in classes, laboratories and on field trips for unsafe or rule-breaking concerns.
- Taught courses under guidance of senior instructors.
Administrative Support Assistant
Las Vegas Metropolitan Police Dept
11.2003 - 04.2007
- Streamlined office processes by implementing efficient administrative procedures, resulting in increased productivity.
- Managed high volumes of incoming calls and emails, ensuring timely responses and accurate information dissemination.
- Maintained a well-organized filing system for easy access to important documents, improving overall efficiency.
- Provided exceptional customer service by addressing inquiries promptly and professionally, nurturing positive client relationships.
- Collaborated with cross-functional teams to complete projects on time and within scope, meeting organizational objectives.
- Coordinated travel arrangements for executives and staff members, ensuring seamless itineraries and cost-effective accommodations.
- Implemented new software systems that streamlined data entry tasks, resulting in reduced errors and enhanced accuracy.
- Developed training materials for new hires, expediting their integration into the workplace while maintaining high performance standards.
- Handled confidential information with discretion, maintaining trust among colleagues and clients alike.
- Served as a liaison between departments to ensure clear communication channels were established for effective collaboration on projects or initiatives.
- Created organized systems for ordering office supplies regularly, reducing downtime due to lack of necessary materials.
- Assisted executives with various day-to-day tasks such as calendar management and correspondence handling.
- Consistently recognized for maintaining a professional demeanor and providing exceptional support to both colleagues and clients.
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Executed record filing system to improve document organization and management.
- Received and sorted incoming mail and packages to record, dispatch, or distribute to correct recipient.
- Developed strategies to streamline and improve office procedures.
- Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
- Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.
- Volunteered to help with special projects of varying degrees of complexity.
- Identified and recommended changes to existing processes to improve accuracy, efficiency, and quality service.
- Transcribed and organized information to assist in preparing speeches and presentations.
- Improved office efficiency by developing and maintaining a comprehensive filing system for all legal documents.
- Assisted with trial preparation, including the organization of exhibits and witness coordination.
- Contributed to successful case outcomes through meticulous proofreading of briefs and other legal materials.
- Organized documents to manage paper and electronic filing systems of clients.
- Prepared and drafted correspondence and legal forms to maintain smooth communications.
- Worked alongside attorneys, administrative assistants, and fellow legal assistants on complex cases and legal processes.
- Prepared for court hearings by organizing and summarizing documents, preparing exhibits and reviewing evidence.
Education
Bachelor of Arts For Teaching - Early Childhood Education
College of Southern Nevada
Las Vegas, NV08.2008
GED -
Mohave High School
Bullhead City, AZ05.2000
Skills
- Reminder Calls
- Medical Insurance
- Chart Pulling
- Family Medicine
- Patient Registration
- Office Administration
- Bookkeeping Support
- Insurance Information Collection
- Customer Service
- Medical Services Administration
- Clinical Data Entry
- Spreadsheet Tracking
- Bilingual in Spanish and English
- HCPCS Compliance
- Billing Issue Resolution and Support
- IDX Systems
- Clerical and Filing Support
- Business Management Principles
- Managing referrals
- Patient Referrals
- Specialist Referrals
- Specialized Healthcare Referrals
- Claim referrals experience
Additional Information
Mestizo Folklorico Dance Group August 1994 – November 2000 President and Vice President
CCFA (Crohn's & Colitis Foundation of America) May 2010 – May 2011 Team member
Rebel in a Box Productions Head of Hair, Makeup & Wardrobe Department Makeup Artist & Hair Stylist (Glamorous Mayhem) 2000- Present
Timeline
Patient Service Representative
HealthCare Partners Medical Group
12.2018 - 12.2023
Medical Records and Health Information Technician
Intermountain Healthcare
12.2018 - 12.2023
Medical Claims Examiner
Intermountain Healthcare
12.2018 - 12.2023
Billing Specialist & Receptionist
Amerisent Insurance
12.2017 - 12.2018
Assistant Manager
Wine And Canvas
02.2014 - 03.2015
Makeup Artist / Product Specialist/Counter Manager
MAC Cosmetics
11.2013 - 05.2017
Instructional Assistant
Clark County School District, CCSD
01.2007 - 10.2009
Administrative Support Assistant
Las Vegas Metropolitan Police Dept
11.2003 - 04.2007
Bachelor of Arts For Teaching - Early Childhood Education
College of Southern Nevada
GED -
Mohave High School
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