Selena Sanchez
Houston,TX
Summary
A highly organized and detail-oriented professional with extensive experience in healthcare administration. Proven ability to manage high volumes of tasks, including insurance verification, scheduling surgeries, and patient communication, while ensuring accuracy and efficiency. Known for delivering exceptional customer service, fostering strong relationships, and providing seamless operational support in various-paced medical environments.
Overview
3
3
years of professional experience
Work History
Claims Specialist
United Health Care
Houston, TX
05.2024 - Current
- Verify insurance benefits to ensure proper coverage and eligibility for medical services.
- Effectively review and research claims, contacting payers to verify detailed denial reasons and resolving discrepancies as needed.
- Analyze patient records to accurately assign the responsible Attending Physician and Clinical Service in line with established guidelines.
- Serve as the main point of contact for patients, gathering accurate insurance information and addressing any concerns or inquiries related to coverage.
- Manage the appeals and reconsideration process for denied or rejected claims, ensuring timely resolution in compliance with insurance policies.
- Research and navigate complex insurance policies and benefits, identifying policy exclusions for patients and providing clear explanations.
- Post electronic and manual payments accurately, reconciling insurance and patient payments to ensure all financials are up to date.
- Communicate denial/rejection trends to management, contributing to strategic decision-making for process improvements.
Insurance Verification Specialist
Legacy Community Health
Houston, TX
08.2022 - 05.2024
- Verified medical insurance coverage across multiple providers, ensuring accurate processing of claims and services.
- Handled the verification of up to 100 patients daily, maintaining high accuracy and efficiency in a fast-paced environment.
- Demonstrated exceptional customer service by addressing patient inquiries and resolving concerns both in person and over the phone.
- Assisted customers by providing clear information regarding their insurance coverage, claims status, and eligibility requirements.
- Assessed and resolved customer complaints by researching and providing appropriate solutions in line with organizational policies.
- Maintained data integrity by updating and managing client and staff records, ensuring compliance with confidentiality standards and healthcare regulations.
Clerical Secretary
Texas Children's Hospital Medical Center
Houston, Texas
04.2022 - 08.2022
- Answered multi-client and business phone systems, effectively managing calls and inquiries in a fast-paced healthcare environment.
- Scheduled add-on surgeries and emergency cases, ensuring timely and efficient coordination for patient care.
- Alerted on-call staff promptly as needed, maintaining operational efficiency in urgent situations.
- Arranged organ harvesting with LifeGift, ensuring all necessary procedures were completed in accordance with medical and ethical standards.
- Advised patients on co-pays and managed work collections, providing clear and accurate financial guidance.
- Coordinated and scheduled operating rooms, surgeons, and assistants as required, supporting surgical operations and smooth patient flow.
- Completed necessary paperwork for surgical procedures, ensuring all documentation met hospital requirements.
- Assisted with insurance verification for surgeries and medical procedures, confirming coverage and patient eligibility.
- Relayed instructions to patients and families, educating them on procedures and answering questions to alleviate concerns.
- Supported physicians, staff, and the surgical team by managing all administrative tasks related to surgical processes and procedures.
- Established and maintained strong customer relationships, providing follow-up support as needed.
- Provided prompt, accurate, and friendly customer service, responding to inquiries regarding insurance availability, eligibility, coverages, policy changes, transfers, claim submissions, and billing clarification.
Front Office Coordinator
United Medical Association LLC
Houston, TX
08.2021 - 04.2022
- Verified medical insurance coverage to ensure accurate billing and processing of surgical procedures.
- Scheduled surgeries for both hand orthopedic doctors and plastic reconstructive trauma surgeons across multiple HCA hospitals, including Lone Star Surgical Center.
- Accessed hospital portals to retrieve operative reports, consultation notes, and fact sheets related to surgeries performed by physicians.
- Printed progress notes for clinic visits and surgical follow-ups, ensuring all documentation was up to date.
- Uploaded important medical documents into patient charts, maintaining accuracy and compliance with medical records standards.
- Sent out therapy referrals for post-surgical care and rehabilitation, coordinating patient care plans.
- Received and processed all doctors' faxes, ensuring timely communication and information exchange.
- Checked patients in and out of exam rooms, facilitating smooth patient flow during appointments.
- Verified authorization for pending surgeries, ensuring compliance with insurance and hospital requirements.
- Answered multi-line phones, providing responsive and efficient communication to patients and staff.
- Responded to emails and inquiries in a timely manner, managing communication with patients and healthcare professionals.
- Uploaded reports and medical records into Azalea Health following surgeries, pulling data from the HCA system to ensure accurate post-operative documentation.
Education
High School Diploma -
John. H Reagan
Houston, TX01-2014
Skills
- Verbal Communication
- Complex claims consulting
- Inspection report review
- Forms validation
- Coverage assessments
- Settlement coordination
Timeline
Claims Specialist
United Health Care
05.2024 - Current
Insurance Verification Specialist
Legacy Community Health
08.2022 - 05.2024
Clerical Secretary
Texas Children's Hospital Medical Center
04.2022 - 08.2022
Front Office Coordinator
United Medical Association LLC
08.2021 - 04.2022
High School Diploma -
John. H Reagan
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