MELINDA L. CELIS
Italy,TX
Summary
Well-qualified Training Specialist adept at planning and implementing onsite and remote training programs. Authoritative and clear communicator with an enthusiastic style and insightful approach. An ambitious medical professional with more than 20 years of experience in patient care, registration, insurance verification, medical billing, and debt collection, from insurance, patient, or 3rd party payers. Also knowledgeable and dedicated customer service professional with extensive experience in the retail and call center industry. Strong team leader with analytical problem-solving skills, outgoing positive demeanor, and willingness to take on added responsibilities to meet office/team goals.
Overview
16
16
years of professional experience
Work History
Epic Principal Trainer
Methodist Health System
02.2021 - Current
- Assist current employees with any Epic issues in Cadence, Prelude, or Referrals
- Strong communication skills to interact with trainees as well as all hospital personnel
- Build out of user, provider, and patient criteria for the training environment
- Maintain that all training material is current in workbooks and training environment.
- Facilitated virtual, in-person, and blended learning sessions.
- Follow all company policies and procedures to deliver quality work
- Created unique materials to support training programs.
- Trained and mentored up to 70 new personnel hired to fulfill various roles per class.
Resolution Specialist (Temp.)
Walmart
10.2022 - 05.2023
- Recorded details of conversations, complaints, and actions taken in CRM.
- Identified and assessed customer's needs quickly and accurately.
- Collaborated with 2 teams to resolve customer complaints and drive customer experience.
- Defined loyalty offer strategy to maximize ROI while staying within budget constraints.
- Educated customers about billing, payment processing, and support policies and procedures.
- Exhibited high energy and professionalism when dealing with customers, clients, and staff.
- Met customer call guidelines for service levels, handle time, and productivity.
- Delivered prompt service to prioritize customer needs.
- Worked effectively in fast-paced environments.
- Demonstrated respect, friendliness and willingness to help wherever needed.
AR Specialist II
Methodist Health System
08.2018 - 02.2021
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Located errors and promptly refiled rejected claims.
- Examined patients' insurance coverage, deductibles, insurance carrier payments, and remaining balances not covered under policies when applicable.
- Identified and resolved patient billing and payment issues.
- Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
- Posted and adjusted payments from insurance companies.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Filed and updated patient information and medical records.
- Liaised between patients, insurance companies, and billing office.
- Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
Epic PB Credentialed Trainer/Patient AR Team Lead
Methodist Health System
01.2017 - 08.2018
- Trained and mentored all new personnel hired to fulfill various roles.
- Create and Construct training utilizing PowerPoint presentations for training
- Assist with all support issues on PB side before and after Go-Live
- Communicate coding and /or payer issues with managers and facilities daily
- Process appeals and claim submissions to commercial, government, and 3rd party insurance payers
- Charge entry including access to add modifiers when needed
- Verify ICD9/ICD10 & CPT coding submitted was accurate for maximum reimbursement
- Follow-up on denied claims, correspondence, and account reconciliations, to achieve maximum reimbursement in a timely manner for commercial, government, and 3rd party insurance payers
- Strong communication skills to effectively collect and negotiate patient payments
- Established and maintained quality control standards
Clinical Secretary
Methodist Health System
08.2016 - 01.2017
- Patient registration, admission, and discharge
- Obtain current and accurate demographic and insurance information from patients
- Obtain proper consent forms, referrals, and pre-certifications for procedure/ treatment
- Liaison between physicians, clinical staff, and patients
- Charge entry, ICD9/ICD10 & CPT coding/billing
- Carried out front office duties utilizing data entry skills
- Organized and maintained patient chart filing system to promote quick data finding for hospital and staff.
- Completed administrative patient intakes with case histories, insurance information, and mandated forms.
Senior Patient Account Representative
Methodist Health System
09.2015 - 08.2016
- Trained new staff on filing, phone etiquette, and other office duties.
- Assure billing information correct to minimize reimbursement risks and receive maximum reimbursement
- Provide administrative and clinical support to physicians, clinical staff, and patients at all times
- Charge entry, ICD9 & CPT coding/billing
- Balanced deposits and credit card payments each day
- Answered incoming calls, scheduled appointments, and filed medical records.
- Greeted and assisted patients with check-in procedures.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
- Contacted patients after insurance was calculated to obtain payments
- Prepared reports detailing billing actions, flags and other key information
- Applied administrative knowledge and courtesy to explain procedures and services to patients
Access Services Representative
Baylor Scott & White Hospital
07.2012 - 12.2015
- Patient check-in/check-out
- Strong communication skills to effectively collect and negotiate patient payments
- Stayed calm under pressure and successfully dealt with difficult situations.
- Collected and entered patient demographic and insurance data into the computer database to establish patient medical records.
- Liaison between management, physicians, clinical staff, patients, and family members of the patient
- Assure billing information correct to minimize reimbursement risks and receive the maximum reimbursement
- Conduct full patient registration at bedside or during emergency situations
- Received patient deductibles and co-pay amounts and discussed options to satisfy the remainder of patient financial obligations.
Surgery Coordinator /Medical Office Assistant
Southwest Colon & Rectal Clinic
07.2007 - 09.2015
- Train and oversee back-office staff
- Provide administrative and clinical support to Physicians and patients at all times
- EMR documentation and uploading
- Contact patients with biopsy reports and any additional follow-up information per doctor's request
- Maintain Colonoscopy re-calls and surgery follow-ups
- Charge entry, ICD9 & CPT coding/billing/claim follow-up
- Registered patients and completed associated paperwork for accurate records
- Educated patients on preparing for surgery and provided treatment plan documentation
- Managed master physician and office calendar for 2 providers, multiple locations
- Obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
- Expertly managed planning, scheduling, and coordination of outpatient procedures.
- Coordinated with facilities to set up surgeries for 3 Colo-Rectal Surgeons
- Collated pre-operative lab and imaging results to facilitate surgery planning.
Education
High School -
Sunset High School
Dallas, TX05.1995
Skills
- Medical Claim Billing/Denial Resolution
- Insurance Verification/Coordination
- Medical Terminology Knowledge
- DRG assignment
- Patient Registration
- Verbal and Written Communication Etiquette
- Customer Inquiry Resolution
- Bilingual in Spanish and English
- Call Center Processes
- Calm and Professional Under Pressure
- Met and Exceeded Call Volume and Quality Metrics
Timeline
Resolution Specialist (Temp.)
Walmart
10.2022 - 05.2023
Epic Principal Trainer
Methodist Health System
02.2021 - Current
AR Specialist II
Methodist Health System
08.2018 - 02.2021
Epic PB Credentialed Trainer/Patient AR Team Lead
Methodist Health System
01.2017 - 08.2018
Clinical Secretary
Methodist Health System
08.2016 - 01.2017
Senior Patient Account Representative
Methodist Health System
09.2015 - 08.2016
Access Services Representative
Baylor Scott & White Hospital
07.2012 - 12.2015
Surgery Coordinator /Medical Office Assistant
Southwest Colon & Rectal Clinic
07.2007 - 09.2015
High School -
Sunset High School
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