Melissa Pilaluisa
Woodbridge,VA
Summary
Pragmatic Insurance Verification Specialist touting 10+ years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.
Overview
15
15
years of professional experience
Work History
Insurance Verification Specialist
North American Partners In Anesthesia
08.2021 - 11.2023
- Assured timely verification of active insurance coverage using major insurance websites.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Researched and corrected insurance information on claim denials.
- Called insurance carriers to verify effective dates and individual patient benefits.
- Managed over 85 insurance verifications within pressured timeframes.
- Reviewed medical records for insurance coverage and procedure-related diagnosis related to worker's comp
- Maintained productivity log using Excell
- Experience using Excell
- Experience using Athena software
- Participated in weekly meetings via Zoom
Ophthalmic Technician / Receptionist
Northern Virginia Ophthalmology
06.2011 - 08.2021
- Assisted multiple doctors in patient care
- Recorded patient history to help ophthalmologists determine diagnoses and treatment plans
- Checked patients in and out
- Collected copayments and balances
- Scheduled appointments
- Verified insurance eligibility and deductibles
- Prepared medical records
- Performed complete ophthalmic history and preliminary examinations
- Performed tonometry, visual acuity, pachymetry, refractions, contact lens fittings, and subspecialty test
- Operated, calibrated, and maintained ophthalmic instruments and equipment
- Submitted prescriptions to pharmacy
- Assisted with minor surgical and laser in-office procedures
- Educated patients on pre and post-cataract surgery care.
Admitting Representative
Sentara
10.2019 - 03.2020
- Verified patient details and insurance coverage and collected co-pays.
- Registered patients for labs, surgeries and radiology.
- Calculated collectible amount due for procedures.
- Arranged forms and charts for each patient.
- Handled admission processes and discharge procedures to transfer patients from hospital to home care, extended facility and self-care plans.
- Verified patient insurance eligibility and entered patient information into system.
- Greeted and assisted patients with check-in procedures.
- Provided excellent customer service to patients and medical staff.
- Followed document protocols to safeguard confidentiality of patient records.
- Trained new staff on filing, phone etiquette and other office duties.
Receptionist
Mount Vernon Cardiology Associates
09.2008 - 06.2011
- Answered multi-line phone system
- Confirmed and scheduled appointments
- Checked patients in and out
- Collected copayments
- Performed INR checks on patients
- Prepared medical records
- Obtained insurance eligibility and pre-certification
- Faxed and prepared pre-op clearances
- Experience with Med Manager and Nextgen Systems.
Education
JCAHPO
City of Elizabeth, NJT.C. Williams High School
Alexandria, VA01.2008
Skills
- Fluent in English and Spanish
- Team Collaboration
- Customer Service Assertiveness
- Communication and Interpersonal Skills
- Organization and Time Management
- Computer literate
- Adaptability
- Remote Experience
- Attention to Detail
- Proficient in Athena Software
- Proficient in Excell
- Proficient in Workday
- Eligibility Determination
- Medical Terminology
- Claims Processing
- Medicare and Medicaid Knowledge
Timeline
Insurance Verification Specialist
North American Partners In Anesthesia
08.2021 - 11.2023
Admitting Representative
Sentara
10.2019 - 03.2020
Ophthalmic Technician / Receptionist
Northern Virginia Ophthalmology
06.2011 - 08.2021
Receptionist
Mount Vernon Cardiology Associates
09.2008 - 06.2011
JCAHPO
T.C. Williams High School