Quinesta Pounds
AcariaHealth Pharmacy
Houston,TX
1
Certification
26
years of professional experience
Management professional offering over 15 years' experience supporting office operations in healthcare setting. Well versed coordinating training programs to improve staff productivity. Highly skilled managing client relations, banking, and insurance processes. Strong work ethic, sound judgment and decision-making skills.
Experienced with evaluating insurance claims to ensure compliance with policies and regulations. Utilizes strong analytical skills to identify discrepancies and facilitate accurate resolutions. Track record of maintaining detailed records and providing exceptional customer service.
Work History
Claims Analyst
3 Months- Collaborated with cross-functional teams to resolve complex claim issues efficiently.
- Developed and implemented process improvements, enhancing claim resolution timelines.
- Analyzed claims data to identify trends and discrepancies, ensuring accurate processing.
- Trained junior analysts on best practices for claims evaluation and management.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Process first-time claims
- Apply policy and provider contract provisions to determine if the claim is payable.
- Research and determine status of medical-related claims
- Maintain records, files, and documentation as appropriate.
- Meet and maintain department production and quality standards.
- Perform other duties as assigned.
- Comply with all policies and standards.
- Conducted audits of claims submissions to ensure adherence to company policies and regulations.
- Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
Insurance Verification Specialist
2 Years- Obtain and verify insurance eligibility for services provided and document complete information in the system.
- Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies.
- Collect any clinical information such as lab values, diagnosis codes, etc.
- Determine patient’s financial responsibilities as stated by insurance.
- Coordinate benefits information on every referral.
- Ensure assignment of benefits is obtained and on file for Medicare claims.
- Bill insurance companies for therapies provided
- Document all pertinent communication with patient, physician, and insurance company as it may relate to collection procedures.
- Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third-party assistance programs, and manufacturer assistance programs.
- Handle inbound calls from patients, physician offices, and/or insurance companies.
- Resolve claim rejections for eligibility, coverage, and other issues.
- Perform other duties as assigned.
- Comply with all policies and standards
Front Desk Receptionist
4 Years 4 Months- Supported high-volume orthopedic office by assisting patients with registration and processing payments, including insurance claims and credit card transactions.
- Reported to the office manager by greeting patients, scheduling appointments, and resolving issues with payments and scheduling.
- Assist management with administrative and clerical projects.
- Accomplishments:
- Recognized for outstanding customer service and ensuring all payments are processed accurately.
Office Manager
4 Years 4 Months- Organized office operations, documented pertinent data into charts, reviewed, and approved supply requisitions.
- Monitored clerical functions processed, kept track of incoming payments, accounts, scheduled meetings and appointments.
- Prepared and sent out invoices, bills, bank deposits, and planned in-house parties.
- Performed daily financial transactions which included, classifying, computing, posting, verifying, recording accounts receivable data, prepared to send out invoices, bills, and bank deposits.
- Organized and filed pertinent data in the client's medical records, a daily audit of therapist notes, and charges to confirm submission of accurate billing.
- Updated demographic and insurance information, and appropriate timely claims processing into patient billing.
- Organized and filed pertinent data in the client's medical records, a daily audit of therapist notes, and charges to confirm submission of accurate billing.
- Accomplishments:
- Streamlined office processes; improved production and verified insurance benefits and eligibility of health care coverage of the patients before services are provided.
Driver/Mental Health Tech
6 Years- Ensured physical needs are met for all clients by assisting with ADLs.
- Assisted with client data collection and assessment, including vital signs.
- Reported observations and pertinent client information to medical personnel and documented data in charts.
- Highlighted key achievements
- Maintained excellent services and care of medically challenged individuals.
Division Manager
7 Years 7 Months- Recognized for outstanding leadership and management skills directing operations for 8 years.
- Maintained records of accounts and petty cash, scheduled staff and client activities, and ensured compliance with state requirements.
- Ensured homes met cleanliness standards and complied with state regulations, addressing client medical needs effectively.
- Recorded appointments, trained staff, and organized files to support operational efficiency.
- Recorded appointments; trained staff and ensured files were maintained.
- Accomplishments:
Education
Associate of Science - Medical Coding and Billing
Associate of Applied Science - Medical Assistant Received Certification
High School Diploma - General Studies
Skills
Claims Processing
Claims Auditing
Claims Documentation
Insurance
Insurance Billing
Reporting
Technical skills
Detail-oriented organization
Scheduling Meetings
Stakeholder Engagement
Management
Communication Skills
Office software proficiency
Certification
- Medical Assistant Certificate
Timeline
Claims Analyst
Centene
05.2026 - CurrentRead More
Insurance Verification Specialist
AcariaHealth Pharmacy
08.2024 - CurrentRead More
Front Desk Receptionist
All American Orthopedic
01.2020 - 05.2024Read More
Office Manager
Oceans Behavioral Health IOP
04.2015 - 08.2019Read More
Driver/Mental Health Tech
Medical Management Options (MMO)
04.2009 - 04.2015Read More
Division Manager
Louisiana CNI, LLC
07.2000 - 02.2008Read More
Antonelli College
Associate of Science from Medical Coding and Billing
Read More
National Education Center
Associate of Applied Science from Medical Assistant Received Certification
Read More
John F. Kennedy Sr. High School
High School Diploma from General Studies
Read More