Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. My experience is in all areas of medical office administrative work to include data entry, patient scheduling, health insurance benefits verification, prior authorization and revenue cycle management. Managed multiple providers credentialing and re-credentialing with major insurance corporations for medical practice.
Overview
7
7
years of professional experience
Work History
RS-Specialist
Healthcare Support Services
Maitland, FL
05.2022 - 04.2024
- Facilitate inbound calls for authorization status or requirements for outpatient and inpatient services
- Used critical thinking to break down problems, evaluate solutions and make decisions
- Verify eligibility for members and network participation for providers
- Reviewed authorization requests to ensure authorization requests are documented in the utilization management system and are in accordance with policies and procedures
- Transfer calls to appropriate departments when applicable
- Met QA requirements and key performance metrics monthly
Customer Service Advocate II
Centene Corporation
06.2024 - Current
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Managed high call volume during peak hours, prioritizing urgent cases while maintaining attention to detail.
- Maintained a positive work environment, fostering team collaboration and continuous improvement.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Met customer call guidelines for service levels, handle time and productivity.
Patient Account Rep
Momentum Physical Therapy
San Antonio, TX
01.2020 - 05.2022
- Accurately and thoroughly document pertinent collection activity performed
- Edit and update claim information to meet and satisfy billing compliance guidelines for electronic and paper claim submission
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Electronically submitted bills according to compliance guidelines.
- Contacted patients after insurance was calculated to obtain payments.
- Reconciled statements with patient records.
- Posted payments and processed refunds.
- Prepared reports detailing billing actions, flags and other key information.
- Participate in monthly meetings, seminars, and hands-on training and identify trends and claim-related issues.
Receptionist
Dr. Nora I. Valdes Primary Care
San Antonio, TX
03.2018 - 01.2019
- Confirmed appointments, communicated with clients, and updated client records.
- Verification of insurance eligibility and benefits
- Collection of patient copays and account receivables.
- Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
- Kept reception area clean and neat to give visitors positive first impression.
- Handled cash transactions and maintained sales and payments records accurately.
Education
A.A.S Medical - Office Administration
2017
A.A.S Medical - Office Specialist
2001
Skills
- Analytical and Critical Thinking
- Remote Office Availability
- Excellent Communication
- Microsoft Software Proficiency
- Customer Relations
- Data Entry
- Data Management
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Customer Service Advocate II - Centene Corporation
06.2024 - Current
RS-Specialist - Healthcare Support Services
05.2022 - 04.2024
Patient Account Rep - Momentum Physical Therapy
01.2020 - 05.2022
Receptionist - Dr. Nora I. Valdes Primary Care
03.2018 - 01.2019
National American University - A.A.S Medical, Office Administration
Hallmark Institute of Technology, Main - A.A.S Medical, Office Specialist
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