Marlysse Fuentes Ayala
Orlando,FL
Summary
Goal-oriented healthcare professional with 6+ years of leadership in customer service and operations. Highly organized, efficient, able to coordinate tasks to achieve projects in a timely manner with minimal supervision, and ability to maintain and exceed department standards. Diverse experience includes authorization, patient experience, collections, insurance, mentoring, client service, and e-commerce.
Overview
14
14
years of professional experience
1
1
Certification
Work History
CONSUMER ACCESS SUPERVISOR
REVENUE CYCLE, ADVENTHEALTH ORLANDO
06.2018 - Current
- Complete time and attendance, audits, and evaluations
- Ensures employee performance and attendance documentation is current and accurate
- Present written and verbal directions to employees to ensure they are well-informed about their job requirements
- Accountable for the day-to-day functions of the team and send daily reports
- Participate and collaborate hospital leadership and other hospital staff to continuously raise the level of service provided to the hospital’s customers
- Monitors departmental activity to assure compliance with regulatory agencies, corporate policies, or third-party payers
- Taking responsibility for service partners satisfaction, employee engagement scores, and meeting goals set by department
- First point of contact for all communication with service partners and acts as the first stage of the escalation process to management; maintain efficient working relationships with all service partners and managers
- Support cross-functional collaboration with all departments by establishing rapport and maintaining open lines of communication to quickly identify and correct issues
- Serve as a resource and subject matter expert for the Inpatient team
- Managed and oversaw go live for new regional Polk the day-to-day functions of the team
- Created job aids, training guides and IP guides for Inpatient team during EPIC go live
- Assisted with Behavioral health team transition with authorizations
- Complete monthly audits to maintain denial volumes low.
LEAD
PRECERT & AUTHORIZATION REP, ADVENTHEALTH ORLANDO
07.2017 - 06.2018
- Served as first point of contact to the team with any discrepancies
- Supported team by completing accounts whenever reps were out on leave ensuring authorization weren’t delayed
- Assisted the team in meeting monthly metrics, minimize errors
- Assisted with training material as well as creating a manual for new hires
- Exports and creates shift reports, delegates shift worklist for team members Document’s authorization, eligibility, benefits, and financial obligation on patient accounts accurately
- Assisted with the separation of job duties between Utilization management and Inpatient teams
BENEFITS, PRECERT & AUTHORIZATION TRAINER
07.2016 - 07.2017
- Created IP Manual for department wide understanding of the IP process
- Present training material for all team members, providing the tools needed for increasing job accuracy
- Train and mentor new team members in meeting their productivity standards
- Verify up-to-date concurrent authorizations for all in-house patients by utilizing commercial authorization reports and ensuring completion by all team members
BENEFITS, PRECERT & AUTHORIZATION REP, ADVENTHEALTH ORLANDO
06.2015 - 07.2016
- Contacted insurance companies by phone, fax, online portal, and other resources to obtain and verify insurance eligibility and benefits and determine extent of coverage
- Obtains pre-authorizations from third-party payers
- Submits notice of admissions when requested by facility
- Provide authorization assistance to outside venders via phone, fax or email
- Obtains PCP referrals when applicable
- Document’s authorization, eligibility, benefits, and financial obligation on patient accounts accurately
SECURITY REPRESENTATIVE
02.2012 - 06.2015
- Honed excellent customer service for reemployment assistance claimants and the public processing initial or additional claims filed online
- Extensive knowledge of reemployment assistance laws and rules to provide excellent customer service
- Responsible for several complex programmatic functions performed within the processes of their employment assistance program
- Determine issues, concerns, and/or complaints from claimants, employers, and other customers
- Access and research necessary records to either explain the reemployment assistance program at the request of callers
- Directed callers to the appropriate place to file a claim, resolve those issues or refer to the appropriate program specialist or supervisor
EXTERNAL ISSUES PROCESSOR
07.2011 - 12.2011
- Processed documentation provided by First Line Customer Representatives supporting DEO customers seeking assistance with unemployment compensation claims
- Processed and submitted documentation prepared for imaging regarding claim updates
- Contacted claimants regarding incomplete documentation needed to process claims
- Conducted full research of claim prior to payment processing to avoid discrepancies and possible overpayments
- Logged and reviewed mail sent to claimants from the Agency
- Followed security regulations regarding proper disposal of documents
- Reviewed compensation history to provide an overview for the claimant of payment status and reviewed wage earnings toward eligibility and overpayment resolution
CUSTOMER SERVICE
09.2009 - 07.2011
- Assisted claimants with their unemployment benefits by providing information pertaining to their claims, eligibility determinations and qualifications
- Performed data entry to update claimant’s information
- Informed claimants of the laws that govern unemployment compensation, their rights and entitlements
- Made corrections on claims for benefit payment or payment retention, completed vast array forms to compile information required by the Agency of Workforce Innovation
- Assisted in processing payments, emails, rescreening claims and forwarding late reports for the agency
Education
ASSOCIATES DEGREE -
SEMINOLE STATE COLLEGE
CERTIFIED LEAN SIX SIGMA YELLOW BELT PROSCI CERTIFIED CHANGE PRACTITIONER -
Skills
- Technical Abilities
- Knowledge of
- Microsoft Office, Cerner, SunPort, Experian, OneSource, Availity, AHCA, NaviNet
- CPA
- Team Communication
- Quality Assurance
- Industry Trends
- Staff Meetings
- Staff Relations
Websites
Certification
Certified PROSCI CERTIFIED CHANGE PRACTITIONER
Certified LEAN SIX SIGMA YELLOW BELT
Languages
Spanish
Native or Bilingual
Timeline
CONSUMER ACCESS SUPERVISOR
REVENUE CYCLE, ADVENTHEALTH ORLANDO
06.2018 - Current
LEAD
PRECERT & AUTHORIZATION REP, ADVENTHEALTH ORLANDO
07.2017 - 06.2018
BENEFITS, PRECERT & AUTHORIZATION TRAINER
07.2016 - 07.2017
BENEFITS, PRECERT & AUTHORIZATION REP, ADVENTHEALTH ORLANDO
06.2015 - 07.2016
SECURITY REPRESENTATIVE
02.2012 - 06.2015
EXTERNAL ISSUES PROCESSOR
07.2011 - 12.2011
CUSTOMER SERVICE
09.2009 - 07.2011
ASSOCIATES DEGREE -
SEMINOLE STATE COLLEGE
CERTIFIED LEAN SIX SIGMA YELLOW BELT PROSCI CERTIFIED CHANGE PRACTITIONER -
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