Naylea Velazquez
Denton,TEXAS
Summary
Detail-oriented Healthcare Insurance Professional with 16+ years of experience interpreting payer guidelines, verifying member eligibility, coordinating prior authorizations, and resolving complex insurance issues across multiple specialties. Extensive background reviewing medical documentation, ensuring compliance with health plan requirements, identifying discrepancies, and managing high-volume workflows with exceptional accuracy. Recognized for analytical problem-solving, strong attention to detail.
Overview
16
16
years of professional experience
Work History
SPL Referral Coordinator/Team Leader
Neurology Consultants of Dallas
Plano, Tx
05.2024 - Current
- Verify insurance eligibility and benefits to ensure compliance with payer guidelines before services are rendered.
- Review patient documentation for accuracy and completeness to support timely insurance approvals.
- Investigate insurance issues and collaborate with providers, patients, and health plans to resolve discrepancies.
- Route referrals and insurance-related requests to appropriate departments for timely resolution.
- Coordinate patient care while reviewing insurance requirements, referrals, and authorization needs.
- Manage a high-volume workload while maintaining exceptional productivity and attention to detail.
- Maintain accurate HIPAA-compliant documentation within the electronic medical record.
- Provide bilingual support to English- and Spanish-speaking patients.
Referral Coordinator (HMO)
North Dallas ENT
01.2022 - 05.2024
- Applied payer guidelines to obtain prior authorizations while minimizing delays and denials.
- Reviewed payer requirements to determine authorization and referral eligibility.
- Verified insurance coverage, benefits, and member eligibility for specialty services.
- Investigated insurance discrepancies and coordinated resolution with insurance carriers to ensure timely patient care.
- Processed high volumes of referrals accurately, contributing to seamless patient access to specialty services.
- Investigated insurance discrepancies and coordinated with insurance carriers to resolve complex issues.
- Communicated effectively with providers, PCP offices, patients, and insurance representatives to clarify authorization decisions.
Receptionist
THPG Orthopedic Specialist
03.2021 - 01.2022
- Verified insurance eligibility and patient benefits to ensure smooth appointment process.
- Collected patient financial responsibility to facilitate billing and streamline transactions.
- Reviewed registration documentation for accuracy and completeness.
- Collected patient financial responsibility, including copays and deductibles.
- Coordinated appointment scheduling to optimize clinic operations and enhance patient flow.
- Maintained organized electronic medical records supporting billing and insurance processes.
Surgery Scheduler / Referral Coordinator
Madsen Orthopedics
02.2020 - 03.2021
- Coordinated surgical scheduling and reviewed insurance requirements for inpatient and outpatient procedures, ensuring compliance and smooth processing.
- Verified member eligibility and obtained prior authorizations across commercial insurance, workers’ compensation, and auto claims.
- Monitored authorization status and secured insurance approvals to facilitate timely reimbursement and minimize service delays.
- Reviewed medical records and clinical documentation before insurance submission.
- Communicated with providers and insurance representatives to effectively resolve authorization and coverage issues, enhancing patient care continuity.
Medical Referral Coordinator (HMO)
Comprehensive Orthopedics & Sports Medicine
12.2016 - 06.2019
- Processed HMO referrals and prior authorizations following payer policies and medical documentation requirements.
- Reviewed denied authorizations and submitted supporting documentation for reconsideration.
- Verified insurance eligibility and coordinated benefits with multiple insurance carriers.
- Maintained accurate referral documentation while ensuring regulatory compliance.
- Worked efficiently in a high-volume environment while maintaining quality standards.
Emergency Room Clinical Secretary / Referral Coordinator
Methodist Medical Center
05.2014 - 11.2016
- Coordinated referrals and specialty consultations for emergency department patients.
- Verified insurance coverage and initiated authorization requests.
- Reviewed patient information for accuracy and maintained compliant documentation.
- Supported admissions, discharges, and high-volume patient flow.
- Collaborated with physicians, nurses, and ancillary departments to ensure continuity of care.
Referral Coordinator
Glaucoma Associates of Texas
12.2010 - 03.2014
- Reviewed HMO referral and specialty appointment insurance requirements to ensure compliance and facilitate timely access to care.
- Coordinated communication between providers, patients, and insurance carriers.
- Processed medical records to secure insurance approvals, ensuring necessary documentation was available for patient care.
- Processed medical records supporting insurance approvals.
- Maintained accurate documentation to support high-volume operations and streamline referral processes.
Education
High School Diploma -
Plano East Senior High School
Plano, TX, USASkills
- Referral processing
- Prior Authorizations
- Medical Claims Support
- Insurance Eligibility Verification
- Benefits determination
- Medical Necessity Guidelines
- Claims Research & Resolution
- Medical Documentation Review
- Payment and Billing Coordination
- Discrepancy resolution
- Quality Assurance
- Healthcare Regulations & HIPAA
- EMR/EHR management
- Bilingual English/Spanish
Languages
- English
- Spanish
Timeline
SPL Referral Coordinator/Team Leader
Neurology Consultants of Dallas
05.2024 - Current
Referral Coordinator (HMO)
North Dallas ENT
01.2022 - 05.2024
Receptionist
THPG Orthopedic Specialist
03.2021 - 01.2022
Surgery Scheduler / Referral Coordinator
Madsen Orthopedics
02.2020 - 03.2021
Medical Referral Coordinator (HMO)
Comprehensive Orthopedics & Sports Medicine
12.2016 - 06.2019
Emergency Room Clinical Secretary / Referral Coordinator
Methodist Medical Center
05.2014 - 11.2016
Referral Coordinator
Glaucoma Associates of Texas
12.2010 - 03.2014
High School Diploma -
Plano East Senior High School