Melva Flores-Lezama
Insurance Pre-Cert Specialist
Fort Worth,TX
Summary
Friendly and enthusiastic who consistently meets customer service satisfaction goals. Qualified with 15 years in fast-paced customer service.
Works good under pressure. Speak and write fluently in Spanish.
Detail-oriented as Customer Representative and a true team player.
Bringing 17 years of expertise as a professional Customer Service representative. Enthusiastic Customer Representative eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of the ethical and professionalism role. Motivated to learn, grow and excel in the customer service role.
Organized, driven and adaptable with excellent planning and problem-solving abilities. Experience and willingness to take on any challenge. Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results. Efficient Referral Coordinator with 7-years of increasing responsibility in Health industry. Expertise in medical terminology, insurance processes, ICD-9 and CPT codes. Interested in shifting career to become a Health Administrator Manager.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Insurance Pre-Cert Specialist
Cook Children's Medical Center
09.2021 - Current
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Collected premiums and issued accurate receipts.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Maintained confidentiality of patient finances, records and health statuses.
- Checked documentation for accuracy and validity on updated systems.
- Reviewed 30 plus patient cases per week and verified insurance coverage information.
- Communicated verification and authorization status updates with Registration department to facilitate decision-making for patient admissions and insurance coverage.
- Called to confirm appointments and provide patient´s responsibility.
- Processed referral requests from patients, doctors and other health care professionals.
- Responded to patient inquiries to offer timely updates regarding referral status.
- Monitored referrals to foster timely completion and followed up with physicians to facilitate.
- Accessed and reviewed patient records to verify receipt completed referral paperwork.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
Customer Serviced Representative II
The Texas Department Of State Health Services
04.2021 - 08.2021
- Customer service, office and administrative practices and procedures.
- Skills in providing clerical support; With standard office equipment, personal computing equipment and software (such as Microsoft Word, Excel, Teams), electronic mail (Outlook), Power Point, Internet Explorer, Data Entry, answering multi-line phone system, Writing and editing or documents.
- Ability to: Maintain confidentiality. Respond to public inquiries in timely manner, Implement administrative procedures. Interpret rules, regulations, policies, and procedures. Communicate effectively. Provide clear verbal and written instructions in internal and external customers. Prioritize workload and meet deadlines. Reliably work Monday through Friday from 8:00: am to 5:00: pm
- Performing routine (journey-level) customer service work. Work under moderate supervision, with minimal latitude for use of initiative and independent judgement. Responsibilities included responding to and traffic public inquiries for information and/or state services; communicating with public in person and via multi-line phone, mail, email, fax, and internet; providing administrative support to Regional Leadership including data entry, scheduling, assignments, processing letters and other general clerical duties; tracking of incoming mail and packages; and assisting with scheduling and tracking of state vehicles, conference rooms and services.
- Uses software systems to maintain agency records. Communicates verbally and in writing using appropriate business communication, including grammar and spelling.
- Member of Incident Command Structure in response to public health emergencies. Must comply with HHS, DSHS, and Texas Department of Public Safety applicable policies/procedures/standards.
Insurance Pre-Cert Specialist
Cook Children’s Medical Center
04.2019 - 04.2021
- Processed eligibility and benefits verification and authorization requests.
- Communicated effectively with staff, including members of operations, finance and clinical departments.
- Communicated verification and authorization status updates with the Hemocology/Oncology department to facilitate decision-making for patient admissions and insurance coverage.
- Maintained high standards of customer service by building relationships with clients.
- Responded to customer calls within the 1-hour to swiftly resolve issues and answer questions.
- Determined financial needs by assessing existing coverage and aligning new products and services with long-term goals.
- Tracked all pending authorizations to resolve discrepancies and avoid revenue loss.
- Maintained confidentiality of patient finances, records and health statuses.
Medical Receptionist II
Cook Children's Genetics
05.2017 - 04.2019
- Responded to customer requests via telephone and email.
- Entered details such as payments, account information and call logs into computer.
- Copied, logged and scanned supporting documentation.
- Verified data integrity and accuracy.
- Analyzed departmental documents for appropriate distribution and filing.
- Obtained documents, clearances, certificates and approvals from local, state and federal agencies.
- Scheduled, confirmed appointments, verify insurance, and pre-prep charts.
- Answering phones promptly and courteously and maintaining schedules, post office charges, payments and adjustments at end of day.
Billing Insurance Specialist
Obstetrix Medical Group
03.2008 - 04.2017
- Copied, logged and scanned supporting documentation.
- Entered details such as payments, account information and call logs into the computer system.
- Communicated verification and authorization status updates with the department to facilitate decision-making for patient admissions and insurance coverage.
- Presented insurance options to customers in a knowledgeable and efficient manner in order to close sales on new policies.
- Processed eligibility and benefits verification and authorization requests.
- Tracked all pending authorizations to ensure timely resolution and avoid revenue loss.
- Maintained confidentiality of patient finances, records and health statuses.
- Directed calls to appropriate individuals and departments.
- Operated a cash register for cash, check and credit card transactions with 100% accuracy.
- Answered customer telephone calls promptly and in an appropriate manner.
- Processed cash and credit payments rapidly and accurately.
Education
Diploma - Billing and Coding
High Tech Institute
Irving, TX2008
GED -
TCC
Fort Worth, TX03.1999
Skills
- Documentation abilities
- Positive and friendly
- Types 45 WPM
- Customer, People and Detail-oriented
- Strong interpersonal skills
- Employee relations
- NextGen, EPIC, EHR- software
- Exceptional communication skills
- Fluent in Spanish
- Health Insurance Portability and Accountability Act (HIPAA)
- Paper and Electronic Records Scanning
- Regulatory compliance
- Motivated team player
- Trusted key holder
- Work ethic
- Proficient in cash management
- Exceptional time management skills
- Credit card processing
- Stocking
- Quick learner
- Multi-line phone talent
- POS systems knowledge and payment processing
- Customer Information Verification
- Knowledgeable in EPIC/NextGen
- Medical Insurance Specialist
- Interpretation Skills
- Financial Transactions
- Interoffice Correspondence
- Electronic Filing System
- Document Organization
- Microsoft Office
- Accounts Payable and Accounts Receivable
- Team Meetings
- Documentation Review
- Information Services
- Diagnostic Codes
- Insurance Coverage Limits
- Insurance Terminology
- Prior Authorization Processing
- Efficient Service
- Office Support
Websites
Certification
CPR Certified
- Certified Interpreter and Translator through Translation Interpretation Network. Will interpret from English to Spanish and Spanish to English.
Timeline
Insurance Pre-Cert Specialist
Cook Children's Medical Center
09.2021 - Current
Customer Serviced Representative II
The Texas Department Of State Health Services
04.2021 - 08.2021
Insurance Pre-Cert Specialist
Cook Children’s Medical Center
04.2019 - 04.2021
Medical Receptionist II
Cook Children's Genetics
05.2017 - 04.2019
Billing Insurance Specialist
Obstetrix Medical Group
03.2008 - 04.2017
Diploma - Billing and Coding
High Tech Institute
GED -
TCC
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