Melanie Lopez
Corpus Christi,TX
Summary
Dynamic Claims Specialist with a proven track record at ELEVATE PATIENT FINANCIAL SERVICES, excelling in claims processing and documentation management. Recognized for maintaining an error ratio below 5%, I leverage strong communication skills and problem-solving aptitude to enhance team efficiency and ensure timely resolution of complex claims.
Overview
10
10
years of professional experience
Work History
Claims Specialist
ELEVATE PATIENT FINANCIAL SERVICES
Remote
04.2022 - Current
- Reviewed and processed hospital and professional medical claims for accuracy and compliance with insurance guidelines.
- Maintained high productivity levels while managing 45 to 55 accounts daily with an error ratio below 5%.
- Utilized coding systems including CPT, ICD-10, and HCPCS for precise reimbursement coding.
- Verified patient eligibility and coverage benefits prior to claim submission to reduce denials.
- Communicated with insurance companies regarding claim status, appeals, and payment discrepancies.
- Ensured timely resolution of outstanding claims through regular follow-ups with payers.
- Investigated complex claim issues by analyzing medical records and billing information.
- Trained new staff on claims processing procedures to enhance team efficiency.
Medical Billing Specialist
Priority billing and Credentialing
Corpus Christi, Texas
02.2018 - 04.2022
- Resolved patient inquiries and concerns while collecting outstanding balances from patients and insurance carriers.
- Collaborated with teams to address recurring billing issues for insurance reimbursement.
- Processed medical claims using advanced billing software, ensuring accuracy and compliance.
- Conducted audits of patient accounts to identify and resolve discrepancies.
- Maintained organized files for patient accounts and billing documentation, adhering to HIPAA regulations.
- Communicated effectively with insurance representatives to resolve claim denials and verify coverage.
- Posted charges, payments, and adjustments, maintaining detailed records of all billing activities.
- Trained new staff on billing procedures and software, enhancing overall team efficiency.
Home Health Scheduler (contract work)
National Nursing and Rehab
Corpus Christi, Texas
04.2017 - 01.2018
- Created and maintained client service schedules based on care plans.
- Coordinated staff shifts according to client preferences and caregiver availability.
- Filled open appointments promptly, addressing last-minute and urgent requests.
- Maintained confidentiality of all records and correspondence.
- Adapted quickly to changes while managing stressful situations effectively.
- Ensured adequate staff coverage across multiple facilities through efficient scheduling.
- Managed appointment bookings and patient admissions for streamlined service delivery.
- Performed data entry for tracking purposes in computer systems.
Durable Medical Equipment Specialist
Maximum Mobility
Corpus Christi, Texas
08.2015 - 03.2017
- Created and maintained authorizations for durable medical equipment and processed insurance claims.
- Managed records such as Certificates of Medical Necessity and authorizations for compliance.
- Reconciled accounts and scheduled appointments for fittings, adjustments, or repairs.
- Ensured submission of all billed claims was timely with an error ratio below 5 percent.
- Maintained production levels by submitting 45 to 50 claims daily.
- Served as liaison among referring providers, payers, and patients for equipment access.
- Educated patients on proper use of durable medical equipment to enhance safety and effectiveness.
- Coordinated delivery schedules for timely installation and service of patient equipment.
Education
GED -
Alice High School
Alice, TX01.2007
Some College (No Degree) - Medical Billing And Coding
Southern Careers Institute
Corpus Christi, TXSkills
- Typing speed 45 WPM
- Eligibility verification
- Claims processing
- Documentation management
- Patient relations
- Claim investigation
- Insurance communication
- Billing compliance
- Compliance management
- Claims analysis
- Computer proficiency
- Multitasking abilities
- Empathy and compassion
- Data privacy awareness
- Time management skills
- Patient intake processes
- Insurance verification expertise
- Problem-solving aptitude
- Quick thinking
- Fast learner
- Self-starter mentality
- Communication skills
- De-escalation techniques
- Adaptability and flexibility
- Attention to detail
- EHR systems knowledge
- MediTech experience
- ARCC familiarity
- Resolve software proficiency
- Epic system expertise
- Brightree utilization
- Cerner applications knowledge
- Accelerate platform experience
- Citrix usage skills
- EFR understanding
- MS4 familiarity
- Traditional Medicare/Medicaid knowledge
- MAPS/HMO expertise
EHR Systems
- MediTech
- ARCC
- Resolve
- Epic
- Brightree
- Cerner
- Accelerate
- Citrix
- EFR
- MS4
Insurances
- Traditional Medicare/Medicaid
- All MAPS/HMO
- All Commercial Payers
References
References available upon request.
Timeline
Claims Specialist
ELEVATE PATIENT FINANCIAL SERVICES
04.2022 - Current
Medical Billing Specialist
Priority billing and Credentialing
02.2018 - 04.2022
Home Health Scheduler (contract work)
National Nursing and Rehab
04.2017 - 01.2018
Durable Medical Equipment Specialist
Maximum Mobility
08.2015 - 03.2017
GED -
Alice High School
Some College (No Degree) - Medical Billing And Coding
Southern Careers Institute
Similar Profiles
Marlene MirelezMarlene Mirelez
Behavioral Health Clinical Specialist at Elevate patient financial servicesBehavioral Health Clinical Specialist at Elevate patient financial services
J. Denise BarnesJ. Denise Barnes
Patient Financial Services Representative at Elevate Patient Financial Services LLCPatient Financial Services Representative at Elevate Patient Financial Services LLC
Xenia MartinezXenia Martinez
Patient Advocate at Elevate Patient Financial ServicesPatient Advocate at Elevate Patient Financial Services
Justin RiosJustin Rios
Instrument & Electrical Technician at American Chrome ChemicalInstrument & Electrical Technician at American Chrome Chemical
Christopher GlassChristopher Glass
Captain/ Paramedic at Annaville Fire DepartmentCaptain/ Paramedic at Annaville Fire Department