Perla Lopez
Summary
Health insurance professional with deep knowledge of plan options, regulations, and client needs. Proven ability to analyze and tailor health plans for optimal client satisfaction and compliance. Strong collaborator who adapts seamlessly to changing requirements, ensuring reliable and results-driven performance. Skilled in customer service, policy interpretation, and strategic planning.
Overview
12
12
years of professional experience
Work History
Utilization Management Assistant
TEXAS CHILDREN’S HEALTH PLAN
01.2022 - Current
- Authorization specialist, responsible for indexing and entering referrals from Onbase to EPIC in a timely manner, (I.E. Inpatient, outpatient, PDN, DME, LTSS, clinical administered drugs), uploading clinicals, familiar with medical terminology and concepts used in care management
- Assist providers with authorization status and benefits
- Ensured timely completion of assigned tasks through effective prioritization and time management skills, consistently meeting or exceeding performance expectations.
Bilingual Health Plan Advisor
BLOOM THRIVE INSURANCE
08.2023 - 02.2025
- Confirming Medicare eligibility, collecting and entering demographics, answering prospect’s questions and conducting a needs assessment
- Routing calls to RN’s and Health coaches for monthly clinical check-in’s
Senior Patient Service Rep
HOUSTON METHODIST HOSPITAL
06.2021 - 09.2021
- Responsible for performing patient check in/check out functions and appointment scheduling to facilitate the patient visit experience
- Responsibilities include performing more complex processes related to scheduling or other department related protocols and serving as a role model and mentor to less experienced staff
- Submit accurate claims submission and may perform registration and/or other revenue cycle functions
- Other duties include providing general operations assistance and/or patient service tasks specific to the scope of the department
Ambulatory Service Rep II
TEXAS CHILDREN’S AUTISM & DEVELOPMENTAL PEDIATRICS
12.2018 - 06.2021
- Streamlined appointment scheduling for improved patient experience and reduced wait times.
- Front desk
- Provide excellent customer service, oversees admissions, check-in, welcome desk, register patients
- Schedule appointments in EPIC for providers, making sure no New Patient slot goes unfilled
- Assist families on how long they will be on the waiting list, verified patient insurance eligibility and benefits.
- Managed high call volumes, addressing patient concerns and directing calls to appropriate departments for timely resolution.
- Additionally, I also perform other job related functions, such as making sure faxes and school forms are added correctly in EPIC and onbase.
Financial Clearance Receptionist
MEDIX- MD ANDERSON CANCER CENTER
06.2018 - 12.2018
- Provide excellent customer service to patients and providers, communicate with referral sources, schedule and register new patients, verify insurance information, secure authorizations, and advise patients of their financial responsibility
- Route calls
Star Kids-Service Coordination Call Unit
TEXAS CHILDRENS HEALTH PLAN
06.2016 - 03.2018
- Educate families on resources outside of health plan, ie 211 and HHSC
- Answer incoming calls for parents requesting a service coordinator, perform telephonic screening, assign Service Coordinators according to geographic area and medical need
- Assist with receiving and sending fax to providers, assist with scheduling appointments to perform initial Screening Assessment Instrument (SAI)
- Assisted with training peers in Macess and Touchpoint
- Completed escalated member request within 24 hours
- Provide status of authorizations and process of how to submit prior authorizations
Billing and Coding Specialist
BAYSHORE PEDIATRICS
01.2015 - 01.2017
- ICD-10 and CPT-4 coding, translating, insurance verification, customer service, answer high volume of calls, schedule appointments, receive results, and assist doctors with medical procedures
- Create claims through E-Clinicals and Medisoft
Member services
TEXAS CHILDRENS HEALTH PLAN
07.2013 - 06.2016
- Inbound call center, answer high volume of calls, assign correct PCP to members, market the health plan
- Assist members with bills and verify eligibility for STAR and CHIP
- Worked on member retention projects, assisted outbound department with work load, assisted Claims department with data entry, volunteered in special events for our members, received EPIC training
Sales Agent
RELIANT ENERGY
11.2012 - 06.2013
- Customer service, sales, data entry, answer high volume of calls and transfer calls to the correct department, enroll customers with the correct energy plan
Education
GED -
Houston Community College
Houston, TX01-2010
Skills
- Bilingual
- Strong communication skills
- Call center
- Knowledge of CPT/ICD-10
- Medical terminology
- Experienced in insurance verification
- Appointment scheduling
- 10 key proficient
- Data entry
- HIPAA Certified
- EPIC knowledgeable
- Onbase experience
- Operate basic office equipment
- Problem-solving
- Healthcare
- Multitasking Abilities
- Excellent communication
Timeline
Bilingual Health Plan Advisor
BLOOM THRIVE INSURANCE
08.2023 - 02.2025
Utilization Management Assistant
TEXAS CHILDREN’S HEALTH PLAN
01.2022 - Current
Senior Patient Service Rep
HOUSTON METHODIST HOSPITAL
06.2021 - 09.2021
Ambulatory Service Rep II
TEXAS CHILDREN’S AUTISM & DEVELOPMENTAL PEDIATRICS
12.2018 - 06.2021
Financial Clearance Receptionist
MEDIX- MD ANDERSON CANCER CENTER
06.2018 - 12.2018
Star Kids-Service Coordination Call Unit
TEXAS CHILDRENS HEALTH PLAN
06.2016 - 03.2018
Billing and Coding Specialist
BAYSHORE PEDIATRICS
01.2015 - 01.2017
Member services
TEXAS CHILDRENS HEALTH PLAN
07.2013 - 06.2016
Sales Agent
RELIANT ENERGY
11.2012 - 06.2013
GED -
Houston Community College
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