Nayeli Chavez
Bakersfield
Summary
Experienced Customer Experience Advisor skilled in utilization management and bilingual communication. Focused on resolving complex issues and improving patient satisfaction. Expertise in ICD-10 coding and Salesforce enhances process efficiency and reimbursement outcomes.
Overview
12
12
years of professional experience
2
2
Certifications
Work History
Customer Experience Advisor
Natera Inc.
Pleasanton, CA
12.2024 - Current
- Resolved complaints and escalated complex cases to enhance customer satisfaction.
- Managed communications regarding test status, results, billing, scheduling, and technical issues.
- Interpreted oncology test requirements, including samples, forms, and clinical workflows.
- Collaborated with sales teams and genetic counselors to ensure seamless data flow for clinical trials.
- Maintain security protocols while handling Protected Health Information (PHI).
- Processed patient orders according to provider requisitions.
Patient Access representative III
Atlas Healthcare Systems
Phoenix, AZ
11.2023 - Current
- Obtain and verify insurance authorizations and referrals for medical procedures across 35 outpatient facilities.
- Verify service coverage based on specific insurance plans and benefit package restrictions.
- Create patient estimates based on deductibles, out of pocket maximum, out-of-network benefits, and or out-of-pocket limitations.
- Reconciled account balances, pursued payments, and address denials to maximize reimbursement.
- Managed next-day add-ons for all 35 ambulatory surgery centers efficiently.
- Ensured appropriate ICD-10 codes were utilized for accurate procedure documentation.
- Reviewed patient accounts to identify missing demographic information and contacted patients as needed.
- Conduct utilization management to optimize resource allocation.
Bilingual Call Center Agent
Foundation for California Community Colleges
San Francisco, CA
04.2022 - 12.2023
- Receive inbound calls from clients and their guardians.
- Handle inquiries related to benefits and eligibility.
- Determine eligibility by comparing client information against established requirement.
- Ensured requirements were met for children's program qualification.
- Pandemic EBT card address changes, card replacements, new case building.
- Escalates priority issues, conducts thorough follow-ups on complex matters and provides detailed reports to management.
- Provided detailed reports to management on case outcomes and escalations.
Patient Access Representative
Adventist Bakersfield
Bakersfield, CA
12.2020 - 03.2022
- Gathered comprehensive patient information, including insurance details and demographics.
- Registered patients during admission and discharge processes, ensuring accurate information capture.
- Confirmed insurance coverage and calculated patient liabilities for efficient collections.
- Communicated effectively with families and caregivers regarding patient care and billing procedures.
- Ensured compliance and accuracy in paperwork preparation for inpatient admissions.
- Verified physician orders and attached them to medical records for testing accuracy.
- Prepared and organized documentation for distribution to various units.
- Escorted patients to their appointments, ensuring timely arrivals. to designated areas or coordinated with escorts when needed.
Medical Billing
Hall Ambulance Service
Bakersfield, CA
04.2014 - 03.2020
- Assured efficient and accurate billing of medical insurances to enhance collections.
- Managed billing and collection processes for timely account resolution.
- Maintained active communication with insurance carriers and third-party payors until accounts were settled.
- Negotiated payment terms for current and overdue accounts via direct calls and written correspondence.
- Followed up on unpaid claims and appealed denied claims as necessary to maximize recovery.
- Verified patient insurance eligibility and coverage to ensure proper billing practices.
- Generated monthly aging reports to identify accounts requiring follow-up based on service dates.
- Entered all relevant patient and account data accurately from care reports into the database.
Skills
- Utilization management
- Call center experience
- Medical terminology
- ICD-10 coding
- Salesforce proficiency
- EHR systems
- Epic software
- Bilingual communication (English and Spanish)
- Revenue cycle management
- Project Intellicare expertise
- FirstNet application
- PowerChart usage
- Waystar knowledge
- Microsoft Office proficiency (Word, Excel, PowerPoint)
- Patient admitting processes
- Cost estimates
- HST Pathways familiarity
- Medevolve platform experience
- CurAE system knowledge
- Prior authorization processes
- Referral management
- Twilio
- Five9
Languages
Spanish
Native/ Bilingual
Certification
CHAA
Timeline
Customer Experience Advisor
Natera Inc.
12.2024 - Current
Patient Access representative III
Atlas Healthcare Systems
11.2023 - Current
Bilingual Call Center Agent
Foundation for California Community Colleges
04.2022 - 12.2023
Patient Access Representative
Adventist Bakersfield
12.2020 - 03.2022
Medical Billing
Hall Ambulance Service
04.2014 - 03.2020