Nallely Lopez
San Luis,AZ
Summary
Bilingual (English/Spanish) Healthcare Billing and Claims Specialist with 4+ years of experience in health plan and insurance operations. Skilled in claims analysis, benefits verification, prior authorization review, denial resolution, and accounts receivable follow-up. Additional background includes progressive leadership experience in customer service within a third-party administrator environment. Seeking a remote role in medical billing or revenue cycle operations.
Overview
13
13
years of professional experience
Work History
Member Service Advocate
Blue Cross Blue Shield of AZ
Phoenix, AZ
04.2024 - Current
- Evaluated claim denials and pinpointed root causes to optimize resolution processes.
- Assisted with claim appeals and reconsiderations, ensuring proper documentation and timely follow-up
- Researched and resolved billing discrepancies and claim issues, minimizing delays in payment
- Assisted with accounts receivable activities, including follow-up on unresolved or pending claims
- Analyzed Explanation of Benefits (EOBs) to identify payment errors and coverage issues
- Reviewed and interpreted insurance claims, benefits, and eligibility to support accurate processing and reimbursement
- Coordinated with internal departments (claims, billing, finance) to expedite claim resolution
- Supported billing inquiries and payment-related concerns, ensuring timely resolution
- Maintained accurate and compliant documentation in accordance with HIPAA regulations
- Managed high-volume caseloads with strong attention to detail and accuracy
Member Service Advocate
Convey Health Solutions
Yuma, AZ
11.2021 - 07.2023
- Processed member requests and reviewed coverage and benefit details for accuracy
- Investigated and resolved claims and billing-related inquiries
- Documented account activity and ensured compliance with regulatory and HIPAA standards
- Assisted with issue resolution related to coverage, payments, and eligibility
- Collaborated with internal teams to improve service efficiency and accuracy
Customer Escalations / Supervisor / Quality
Advanced Call Center
San Luis, AZ
03.2013 - 03.2020
- Resolved complex account issues requiring research, analysis, and cross-department coordination
- Conducted audits to ensure accuracy, compliance, and quality standards
- Analyzed error trends and implemented process enhancements.
- Trained staff on procedures, documentation, and quality expectations
Education
High School Diploma -
San Luis High School
San Luis, AZ05.2012
Skills
- Medical Billing & Accounts Receivable
- Claims Review & Resolution
- Prior Authorizations
- Benefits Verification
- Denial Research & Appeals Support
- Payment Posting Support
- Payor Communication & Research
- Healthcare Documentation
- HIPAA Compliance
- Data Accuracy & Analysis
- Bilingual: English & Spanish
Timeline
Member Service Advocate
Blue Cross Blue Shield of AZ
04.2024 - Current
Member Service Advocate
Convey Health Solutions
11.2021 - 07.2023
Customer Escalations / Supervisor / Quality
Advanced Call Center
03.2013 - 03.2020
High School Diploma -
San Luis High School