MELVA FLORES LEZAMA

Department: Plastic Surgery - 11/19/2025 - Current

• Facilitated communication between departments, enhancing collaboration for improved patient care coordination.
• Followed all company policies and procedures to deliver quality work.
• Processed pre-authorization requests efficiently, ensuring timely approvals for patients.
• Developed strong working relationships with physicians'' offices resulting in a smoother flow of required documents when submitting requests.
• Coordinated pre-authorization requirements for medical treatments or services, enhancing overall patient experience before appointments.
• Reduced claim denials by diligently reviewing and correcting errors in authorization submissions.
• Maintained comprehensive knowledge of various insurance plans, ensuring accurate information was provided during the authorization process.
• Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
• Input all patient data regarding claims and prior authorizations into system accurately.
• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
• Responded to inquiries from healthcare providers regarding prior authorization requests.
• Reached out to insurance carriers to obtain prior authorization for testing and procedures.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Maintained confidentiality of patient finances, records, and health statuses.

• 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.
• Schedule appointment from Alliance, Mansfield, and New MMS WQs
• Request Prior-authorizations if need it for out-patient testing at the CCMC (MRI, CT, PET Scans, Ultrasounds, Radiology, Xrays)
• Call and reschedule appointment for the Alliance office when provider is out of the office
• Cover phones when short staff
• Train new employees when necessary
• Cover outlining clinics-front reception. (Mansfield and Arlington).
• Collect co-pay and post at end of day.
• Enter daily data in a spreadsheet for patients deposit log sheet.
• Out on Medical Leave from 04/2022 to 12/2022

• 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 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.

• 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.

• 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.

• 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.