Nancy Abensur Alvarez
Boca Raton,FL
Summary
Experienced and detail-oriented medical insurance professional with expertise in insurance verification, claims processing and case management. Proven ability to manage complex medical cases, ensure compliance with policies and optimize cost containment strategies.
Overview
9
9
years of professional experience
Work History
Insurance Verifier
ENT and Allergy Associates of Florida
02.2020 - Current
- Review daily and weekly Excel spreadsheets to assess the assigned physicians’ schedules and identify patients requiring insurance verification
- Verify patients’ insurance benefits, including co-payments, co-insurance, and deductibles, as well as prior authorization requirements, by accessing the insurance’s website or contacting the insurance company directly
- Accurately complete the patient benefit verification form and upload it to the patient's chart, ensuring that demographic information matches between the insurance website and the internal system to prevent claim processing delays
- Notify patients of their financial responsibility due at the time of service
- Support team collaboration by covering schedules in the absence of team members
- Train new team members and provide guidance on how to perform the insurance verifier duties
Patient Representative
ENT and Allergy Associates of Florida
02.2018 - 02.2020
- Answered incoming calls from patients and efficiently schedule appointments
- Created new patient files by accurately collecting and entering demographic and insurance information into the system
- Assisted patients with questions regarding their insurance benefits as co-payments, deductibles and coinsurance
- Addressed patients' inquiries related to appointments and treatments or directed them to the appropriate personnel for specific medical concerns
- Managed voicemail messages, ensuring timely follow-ups with patients
- Daily monitored physician’s schedule, ensuring appointments were scheduled under the correct time slot or appointment type
- Balanced appointment distribution across all physicians within the practice to optimize scheduling
- Trained new team members and provided guidance on how to perform the patient representative duties
Client Services Coordinator
GMMI - Global Medical Management
12.2016 - 10.2017
- Managed new medical cases from initiation to completion, meaning from opening the case in the system until receipt and handling of medical claims
- Responsibilities included handling inbound and outbound calls with medical providers to provide insurance benefits, fax verification of benefits, coordinating pre-authorizations for medical procedures as well as performing case management
- Maximized cost containment for clients by referring patients to in-network providers and assuring claims from out-of-network providers are negotiated to secure the best possible discounts
- Addressed inquiries related to payments and claims from clients, providers, and patients
- Prepared and distributed weekly reports to clients
- Monitored other department’s performance to maintain high levels of client satisfaction
- Assisted and supported the account manager with various client-related tasks, ensuring efficient handling of client requests and operational needs
Assistance Coordinator Team Lead and Trainer
GMMI - Global Medical Management
07.2016 - 11.2016
- Managed the morning shift, overseeing a team of 6–10 employees to ensure efficient operations
- Trained new team members, providing guidance on department functions, company procedures, and the responsibilities of an assistance coordinator
- Managed the company’s customer service inbox and faxes delegating tasks based on team members’ skills and expertise
- Monitored and evaluated team performance offering support and guidance to address any job-related inquiries
- Conducted monthly performance reviews to assess individual and team progress
- Reviewed and evaluated team members' weekly questionnaire responses to ensure alignment with company standards and expectations
Assistance Coordinator
GMMI - Global Medical Management
11.2015 - 06.2016
- Managed inbound calls from insured individuals, assisting them in locating in-network providers and scheduling appointments
- Handled inbound and outbound calls with medical providers to verify patient eligibility and benefits, initiate case management for inpatient cases, and facilitate the pre-certification and authorization process for medical procedures
- Processed faxes from providers requesting authorization for procedures
- Handled emails from insured members regarding policy coverage, doctor’s visits, medical procedures, and billing inquiries
- Handled emails requests from various insurance carriers to arrange new medical cases
Education
Bachelor Degree - Political Science and Sociology
Bar-Ilan University
01-2013
Skills
Highly organized, self-motivated, detail-oriented, reliable and team player
Quick learner with the ability to acquire new techniques and skills efficiently
Able to work independently while maintaining a high level of productivity
Adhere to policies and procedures
Proficient in Microsoft Office including Word, Excel, PowerPoint and Outlook
Fluent in English, Spanish and Hebrew
Timeline
Insurance Verifier
ENT and Allergy Associates of Florida
02.2020 - Current
Patient Representative
ENT and Allergy Associates of Florida
02.2018 - 02.2020
Client Services Coordinator
GMMI - Global Medical Management
12.2016 - 10.2017
Assistance Coordinator Team Lead and Trainer
GMMI - Global Medical Management
07.2016 - 11.2016
Assistance Coordinator
GMMI - Global Medical Management
11.2015 - 06.2016
Bachelor Degree - Political Science and Sociology
Bar-Ilan University
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