Thalia Perez
Houston,TX
Summary
Dedicated Customer/ Claim Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results.
Overview
11
11
years of professional experience
Work History
Insurance Verification Specialist
Centene
Orlando, FL
05.2024 - Current
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Verified insurance eligibility and benefits, ensuring accurate coverage for members and providers.
- Utilized electronic systems to process and document verification requests.
- Communicated with healthcare providers to gather necessary patient information.
- Identified customer needs and provided timely solutions to enhance service experience.
- Maintained current knowledge through continuing education and advanced training to improve service delivery.
- Help run test claims.
Provider Service Representative
Molina Healthcare
Long Beach, California
10.2022 - 05.2024
- Managed provider inquiries and resolved issues to enhance provider satisfaction.
- Clarified authorization requirements with healthcare providers to streamline processes.
- Processed prior authorization requests using advanced healthcare management systems.
- Handled customer inquiries about insurance policy coverage and payment status to ensure accurate information delivery.
- Utilized claims management software to track and manage claim statuses.
- Provided exceptional customer service through timely responses to inquiries.
CSR
United Concordia/ Highmark
11.2022 - 10.2023
- Answered customer calls promptly, minimizing on-hold times to improve overall customer experience.
- Handled a continuous flow of customer calls, ensuring minimal wait times to support customer satisfaction.
- Managed high call volumes while maintaining professionalism and effectively multitasking to enhance customer interactions.
- Demonstrated empathy and active listening skills, resulting in a higher rate of customer satisfaction and repeat business.
- Provided providers with detailed claim information, including reasons for denials.
Insurance Coordinator
Parker Nickolas Read Dental
10.2020 - 11.2022
- Coordinated insurance verifications, guided patients on benefits, and liaised with insurance companies to ensure timely claims processing.
- Filed, tracked, and updated patients on insurance claims status to enhance transparency and patient understanding.
- Assisted clients with understanding complex insurance policies, effectively addressing concerns or questions.
- Assisted patients in overcoming financial barriers, contributing to healthier aging accounts receivable.
- Managed a high volume of inbound calls, promptly resolving issues while providing accurate information on policies and procedures.
Front Office Assistant
Houston Orthodontic Specialist
07.2019 - 10.2020
- Coordinated patient appointment scheduling, streamlining daily operations for optimal workflow.
- Greeted patients upon arrival, ensuring their needs were met to enhance satisfaction.
- Oversee the schedule during the day to ensure that it runs smoothly
- Modified daily schedule to accommodate patient needs and changes.
- Updated patient addresses, telephone numbers, and insurance information upon arrival.
- Maintained professional, welcoming environment for clients, fostering positive experiences.
- Reviewed and updated customer information in database for accuracy.
- Stabilize the production by scheduling the ideal day
INSURANCE COORDINATOR/FRONT OFFICE
Aqua Dental
05.2015 - 07.2019
- Check In/Out Patients, collected payments, verified Insurance all patients insurance/Medicaid
- Reviewed and processed explanation of benefits payments, ensuring accuracy to facilitate timely reimbursements.
- Contacted insurance for any outstanding claims
- Applied Fee Schedules to the open dental system
- Processed payments for invoices and managed account records efficiently.
- Helped with Marketing/Events
- Managed a high volume of inbound calls, promptly resolving issues while providing accurate information on policies and procedures.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Secured prior authorization and precertification for outpatient procedures, enabling seamless patient care.
- Verified insurance and communicated coverage details to staff and patients, enhancing understanding of benefits and reducing claim issues.
Education
Diploma -
North Shore Senior High School
Houston, TX06-2013
Skills
- Organized
- Insurance verification
- Patient eligibility verification
- Claims processing
- Prior authorization handling
- Conflict resolution
- High attention to detail
- Easy to adapt to new environments
- Fast Learner
- Call center experience
- Customer Focus
- Complaint Handling
- Dependable and Responsible
- Critical Thinking
- Computer Skills
Timeline
Insurance Verification Specialist
Centene
05.2024 - Current
CSR
United Concordia/ Highmark
11.2022 - 10.2023
Provider Service Representative
Molina Healthcare
10.2022 - 05.2024
Insurance Coordinator
Parker Nickolas Read Dental
10.2020 - 11.2022
Front Office Assistant
Houston Orthodontic Specialist
07.2019 - 10.2020
INSURANCE COORDINATOR/FRONT OFFICE
Aqua Dental
05.2015 - 07.2019
Diploma -
North Shore Senior High School