Michelle Nuez
Humble,TX
Summary
Detail-oriented healthcare professional with over 10 years of experience in insurance verification, prior authorizations, and revenue cycle operations. Expertise in collaborating with clinical and administrative teams to ensure accurate documentation, timely reimbursement, and enhanced patient experiences. Proficient in Epic and payer communications, with a strong track record of resolving complex insurance issues. Bilingual and recognized for exceptional attention to detail and commitment to patient-centered service, seeking to transition into a remote insurance verification and eligibility role to further leverage strengths in this field.
Overview
15
15
years of professional experience
Work History
REMOTE Patient Service Rep Medical Assistant
Common Spirit
Houston, TX
09.2025 - Current
- Manage high-volume inbound and outbound patient calls in a fully remote environment while maintaining professionalism and efficiency
- Accurately document patient interactions in real time and route messages to appropriate clinical teams
- Resolve patient concerns and complaints using effective de-escalation techniques and compassionate communication
- Support care coordination by ensuring timely follow-up between patients and providers
- Consistently meet or exceed performance metrics, including adherence, cycle time, patient satisfaction, and telephone quality scores
- Maintain HIPAA compliance and data security standards while working remotely
Sr. Patient Service Representative
Houston Methodist
01.2015 - 09.2025
- Verify insurance coverage and eligibility for in-office and hospital procedures across multiple providers
- Secure prior authorizations for complex services, ensuring compliance with payer requirements and preventing delays in care
- Accurately code diagnoses and procedures using ICD-10, CPT, and HCPCS
- Interpret EOBs and explain coverage, benefits, and financial responsibility to patients
- Post insurance and patient payments while reconciling discrepancies and maintaining accurate account balances
- Collaborate with clinical staff to ensure complete and accurate documentation for claims processing
- Create financial estimates, contracts, and payment arrangements for surgical and outpatient procedures
- Resolve patient billing concerns and insurance-related issues with professionalism and empathy
- Maintain strict HIPAA compliance and adhere to payer-specific billing guidelines
Certified Medical Assistant
Family Health Clinic
Kingwood, TX
01.2011 - 01.2015
- Managed front desk operations, including scheduling, patient check-in, and multi-line phone systems
- Collected and verified patient demographics and insurance information
- Processed insurance claims and supported billing workflows
- Completed prior authorizations and coordinated referrals
- Supported daily clinic operations to ensure efficient patient flow and high-quality service
Patient Service Representative
Women’s Center of Greater Houston
01.2011 - 01.2014
- Verified insurance eligibility and benefits prior to services for commercial, Medicare and Medicaid plans
- Obtained prior authorizations and pre-certifications for procedures and surgeries
- Processed and reviewed insurance claims, identifying and correcting denials for resubmission
- Entered ICD-9, CPT, and HCPCS codes with a high level of accuracy
- Interpreted EOBs to resolve claim discrepancies and ensure proper reimbursement
- Communicated directly with insurance carriers to resolve billing issues
- Posted insurance and patient payments and maintained accurate financial records
- Created financial agreements and payment plans for patients undergoing procedures
Education
Certified Medical Assistant - CMA
Texas School of Business
Houston, TX10-2011
Skills
- Insurance Verification & Eligibility
- Prior Authorizations & Referrals
- Revenue Cycle & Claims Management
- Denial Resolution & EOB Interpretation
- ICD-10, CPT, HCPCS Coding
- Patient Financial Counseling
- Provider-Payer Communication
- HIPAA Compliance
- Remote patient support and call center operations
- High-volume call handling in virtual environments
- Accurate real-time documentation while multitasking
- Strong time management and self-directed workflow
- Virtual communication with cross-functional teams
- Maintaining productivity and quality metrics in remote settings
- Epic Hyperspace
Languages
Bilingual (Spanish)
Timeline
REMOTE Patient Service Rep Medical Assistant
Common Spirit
09.2025 - Current
Sr. Patient Service Representative
Houston Methodist
01.2015 - 09.2025
Certified Medical Assistant
Family Health Clinic
01.2011 - 01.2015
Patient Service Representative
Women’s Center of Greater Houston
01.2011 - 01.2014
Certified Medical Assistant - CMA
Texas School of Business