Monica Vargas
Tyler,TX
Summary
19 years of experience in the clerical industry. Solid team player with outgoing. positive demeanor and proven skils in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
7
7
years of professional experience
Work History
Lead claims representative
Cigna healthcare
Tyler, TX
07.2023 - 02.2025
- Processed and reviewed claims for accuracy and completeness.
- Communicated with clients to gather necessary documentation and information.
- Evaluated claim details to determine eligibility and coverage under policies.
- Utilized claims management software to track and document case progress.
- Maintained organized records of all claims interactions and communications.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Maintained detailed records of all communication with customers, claimants, providers, and internal departments.
- Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
- Documented changes in claim statuses using specialized software systems.
- Adhered to strict guidelines pertaining to confidentiality while handling sensitive personal information.
- Investigated facts, confirmed coverage and liability, negotiated settlements, and determined payments for claims.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
- Interpreted legal documents such as contracts or court orders when evaluating claims for payment.
- Conducted research into medical terminology related to healthcare claims processing activities.
- Reviewed documentation and accounts to gain full picture.
- Participated in audits and reviews of claims to ensure accuracy and adherence to guidelines.
Patient Access Representative
Centauri Health Solutions Inc - Human Arc
Tyler, Tx
01.2022 - 03.2023
- Managed patient registration processes efficiently and accurately.
- Assisted patients with insurance verification and eligibility inquiries.
- Coordinated appointment scheduling for multiple departments seamlessly.
- Collaborated with healthcare staff to ensure smooth patient flow within the facility.
- Maintained patient confidentiality while handling sensitive information diligently.
- Utilized electronic health record systems to update and maintain patient information effectively.
- Educated patients about financial policies and payment options clearly and professionally.
- Applied HIPAA privacy and security regulations while handling patient information.
- Answered phones promptly in a professional manner.
- Scanned documents into electronic medical records system.
- Registered patients by completing face-to-face interviews to obtain demographic, insurance, and medical information.
- Created new patient accounts in EMR system as needed.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Actively participated in team meetings and training sessions.
- Responded to patient inquiries regarding billing or financial matters.
- Conducted financial counseling for patients, explaining payment options and assistance programs.
- Prepared daily reports on registration activities, highlighting areas for improvement.
- Cultivated positive relationships with patients to help facility meet satisfaction scores and patients obtain best possible care.
- Accessed programs and set up correct payment strategies based on patient means and needs.
- Initiated application processes to add patients to assistance programs at bedside and followed through until completion.
- Stayed current on community-based resources and services useful to patients.
- Maintained confidentiality of all patient information in accordance with HIPAA regulations.
- Ensured accuracy of all data entered into computer system.
- Addressed patient inquiries and concerns, resolving issues in a timely and empathetic manner.
- Screened patients for eligibility for state, local and federal assistance programs.
SENIOR PATIENT FINANCIAL COUNSELOR
Christus Trinity Mother Frances Hospital
Tyler, TX
10.2021 - 01.2022
- Organized patient records and database to facilitate Information storage and retrieval.
- Facilitated communication between patients and various departments and staff.
- Followed document protocols to safeguard confidentiality of patient records.
- Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
- Served customers and followed outlined steps of service.
- Prepared a variety of different written communications, reports and documents to ensure smooth operations.
- Performed duties in accordance with applicable standards, policies and regulatory guidelines to promote safe working environment.
- Used data entry skills to accurately document and input statements.
- Monitored outstanding invoices and performed collections duties.
ADVANCED CLAIMS ANALYST AND PROCESSOR
Centene
Tyler, TX
11.2017 - 02.2021
- Identified Insurance coverage limitations with thorough examinations of claims documentation and related records.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Rode over Insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Researched claims and incident information to deliver solutions and resolve problems.
- Maintained confidentiality of patient finances, records and health statuses.
- Generated, posted and attached information to claim files.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Managed large volume of medical claims on daily basis.
- Submitted electronic paper claims documentation for timely filing.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Paid or denied medical claims based upon established claims processing criteria.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Checked documentation for accuracy and validity on updated systems.
- Determined appropriateness of payers to protect organization and minimize risk.
Education
High School Diploma -
Pace High School
Tyler, TX05.2000
No Degree - Healthcare
Tyler Junior College
Tyler, TXSkills
- Documenting and Recording Information
- Registration and Scheduling
- Claims processing
- Claims management software
- Medical terminology
- Insurance verification
- Compliance adherence
- Document management
- Data entry accuracy
- Problem solving
- Time management
- Confidentiality practices
- Documentation research
- Allocating claims
- Claims investigation
- File management
- Documentation review
- Conflict resolution
- Insurance claims review
- Claims trend analysis
- Coverage assessments
- Insurance regulations
- Goal setting
- Caring and Empathetic
- Patient Confidentiality and Data Security
- Quality Standards and Protocols
- Counseling and Guidance
- Punctual and Hardworking
- Insurance Forms Processing
- Benefits Explanation
- Records Management
- Word Processing
- Delinquent Account Monitoring
- Payment Calculation
- Providing Information and Resources
- Safety Monitoring
- Verbal and Written Communication
- Resolving Problems
- Claims Handling and Coverage Verification
- Building Rapport and Credibility
- Microsoft Office
- Gathering Information from Patients
- Time Management and Prioritization
- Spreadsheet Tracking
- Reliability and Dedication
- Attention to Detail
- Communicating to Patients and Families
- 50 WPM Typing Speed
- Multi-Line Telephone Systems
- Organized and Efficient
- Clerical and Filing Support
- Administrative and Office Support
- Collections Management
- Outbound Calling
- Calm and Effective Under Pressure
- Medical Terminology
- Conflict Resolution
- Billing Issue Resolution and Support
Languages
Spanish, Native or Bilingual
Timeline
Lead claims representative
Cigna healthcare
07.2023 - 02.2025
Patient Access Representative
Centauri Health Solutions Inc - Human Arc
01.2022 - 03.2023
SENIOR PATIENT FINANCIAL COUNSELOR
Christus Trinity Mother Frances Hospital
10.2021 - 01.2022
ADVANCED CLAIMS ANALYST AND PROCESSOR
Centene
11.2017 - 02.2021
High School Diploma -
Pace High School
No Degree - Healthcare
Tyler Junior College