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Melissa Galarza
Haines City,FL
Summary
Dynamic customer service leader with a decade of experience in healthcare settings. Proven ability to manage teams, streamline processes, and improve patient satisfaction through effective problem resolution and insurance verification.
Overview
13
13
years of professional experience
6
6
years of post-secondary education
Work History
Insurance Verification Specialist- Customer Services
Sutherland Global Solutions
04.2024 - 04.2026
- Access customer records and verify customer account information.
- Identified potential customer needs and recommended tailored solutions.
- Place follow-up calls to customers to ensure their needs are met in an efficient manner.
- Supported general billing inquiries to strengthen customer relationships.
- Accessed customer databases, knowledge resources, and technical applications to determine root causes and resolutions.
- Collaborated with client departments, including test desk and field service, to address escalations.
- Coordinated technician visits to resolve service requests.
- Improve technical skills: Attend job-related training: new hire and refresher training, new product or service updates and product cross-training.
Benefit Verification Specialist- CVS Specialty Pharmacy
Continuum Global Solutions
11.2021 - 11.2023
- Verified patient-specific benefits with insurance companies, ensuring accurate coverage, cost share, access, provider options, and prior authorization.
- Analyzed and interpreted complex insurance policies and benefits to deliver clear and accurate information to patients.
- Skilled in conducting insurance research and resolving issues.
- Health insurance: in-depth knowledge of health insurance plans and various payer programs.
- Medical terminology: familiarity with medical terminology to accurately interpret and communicate insurance information.
- Data entry and insurance research: accurate and efficient data entry skills for maintaining patient insurance information.
- Established rapport with patients and addressed their questions and concerns through effective communication.
Assistant Coordinating Manager - Credit and Collection
New York City Health + Hospitals Elmhurst
11.2019 - 08.2021
- Supervised and coordinated work of Customer Service Billing Unit, managing a team of Senior Hospital Care Investigators and Hospital Care Investigators.
- Oversaw staff performance by reviewing standards and expectations and providing ongoing feedback.
- Developed and delivered training for Customer Service Billing team on financial management systems (Epic, Soarian, Unity) to enhance resolution of patient billing inquiries.
- Monitor & oversee staff in responding to H+H’s centralized Billing Inquiry e-mails and My Chart In-Basket customer messages.
- Tracked daily customer service metrics, including in-person encounters, calls, emails, waiting times, and walk-outs, adjusting coverage to meet demand.
- Acquired knowledge of payroll processes, garnishments, and benefit distribution methods.
- Checking timesheets for accuracy; resolve payroll errors.
- Participate and represent Elmhurst at H+H’s Customer Service Leadership & Customer Service Work Queue Monitoring meetings.
Health Care Program Planner Analyst- Credit and Collection
New York City Health + Hospitals Elmhurst
08.2013 - 11.2019
- Ensured compliance by verifying and rejecting insurance policies for Medicare and Medicaid Managed Care.
- Rebill claims denied and follow-up to ensure insurance payment for all Payers, Self-Pay, No Fault, and Worker compensation.
- Reviewed EPIC documents, reprocessed and completed billing denial edits to ensure accurate claims submission.
- Generate certified bills for Attorney, subpoena, and other liability cases.
- Managed the opening and closing of chemotherapy encounters by updating Soarian and EPIC with correct drug, unit price, patient diagnosis, and CPT codes.
- Review Pharmacy and Chemotherapy encounters forms to verify drugs that were administered.
- Prepared and distributed reports detailing Chemotherapy drug payments to assist in financial tracking.
- Perform tasks associated with the EDM system, research and compile data to support Soarian financial system and OAM/unity system.
Education
Bachelor Degree - Business Administration Management
Plaza College
NY 01.2015 - 08.2017
Associate Degree - Occupational Studies
Plaza College
NY 01.2010 - 06.2013
Skills
- Insurance verification
- Claims follow-up
- Insurance billing
- Payment processing
- Medical Terminology
- ICD-9 CM
- ICD-10 CM
- HCPCS/AMA CPT Coding
- HIPAA compliance
- Soarian
- EPIC
- Quadra Med
- OAM
- Data entry
- Microsoft Office
- Communication expertise
- Problem Solving
- Team leadership
- Recruitment strategies
- Customer relationship management
- Site management
Offering
Bilingual, bicultural, emotionally intelligent professional with over 10 years of customer services experience within healthcare.
Timeline
Insurance Verification Specialist- Customer Services
Sutherland Global Solutions
04.2024 - 04.2026
Benefit Verification Specialist- CVS Specialty Pharmacy
Continuum Global Solutions
11.2021 - 11.2023
Assistant Coordinating Manager - Credit and Collection
New York City Health + Hospitals Elmhurst
11.2019 - 08.2021
Bachelor Degree - Business Administration Management
Plaza College
01.2015 - 08.2017
Health Care Program Planner Analyst- Credit and Collection
New York City Health + Hospitals Elmhurst
08.2013 - 11.2019
Associate Degree - Occupational Studies
Plaza College
01.2010 - 06.2013