Theresa Dominguez
Alamogordo
Summary
Dynamic Senior Patient Claims Specialist with extensive experience at Gerald Champion Regional Medical Center, excelling in complex claims consulting and documentation review. Proven track record in achieving financial targets through effective claims processing and strong verbal communication skills. Adept at training new employees and fostering teamwork to enhance operational efficiency.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Senior Patient Claims Specialist
Gerald Champion Regional Medical Center
04.2023 - Current
- Followed up with customers on unresolved issues.
- Reviewed insurance and claims documents to verify required information and secure any missing data for claims processing.
- Worked with claims adjusters to expedite processing of billed charges.
- Maintained confidentiality of patient finances, records, and health statuses.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Verified client information by analyzing existing evidence on file.
- Posted payments and adjustments to patient claims.
- Coordinated with contracting department to resolve payer issues.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Checked documentation for accuracy and validity on updated systems.
- Evaluated and settled complex insurance claims in strict timeframes.
- Generated, posted and attached information to claim files.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Reviewed and approved of adjustments requests for patient accounts from other analysts.
- Reviewed and approved of dispute documents for other analysts.
Patient Financial Specialist
Gerald Champion Regional Medical Center
03.2022 - 04.2023
- Handled day-to-day accounting processes to drive financial accuracy.
- Managed and responded to correspondence and inquiries from customers and vendors.
- Evaluated and settled complex insurance claims in strict timeframes.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Assured timely verification of insurance benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient finances, records, and health statuses.
- Generated, posted and attached information to claim files.
Patient Access Representative
Gerald Champion Regional Medical Center
06.2021 - 02.2022
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Helped address client complaints through timely corrective actions and appropriate referrals.
- Resolved customer complaints using established follow-up procedures.
- Facilitated communication between patients and various departments and staff.
- Responded to inquiries by directing calls to appropriate personnel.
- Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
- Followed document protocols to safeguard confidentiality of patient records.
Hospitality Specialist
Gerald Champion Regional Medical Center
02.2018 - 06.2021
- Collaborated with various team members to meet patients' requests.
- Developed and executed strategies to improve customer experience in hospitality settings.
- Exhibited high energy and professionalism when dealing with patients and staff.
- Investigated and resolved customer inquiries and complaints quickly.
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
- Promoted superior experience by addressing patient concerns, demonstrating empathy, and resolving problems swiftly.
- Maintained clean and orderly food prep areas by mopping floors, emptying trash cans and wiping down surfaces.
- Delivered exceptional customer service to every patient by leveraging extensive knowledge of specific diet restrictions and proper foods for these diets. Created welcoming, positive experiences.
- Monitored cash drawers in multiple stations and maintained adequate cash supply.
Operations Assistant
NAF
06.2016 - 05.2018
- Assisted operations manager with planning of routine operations and special projects.
- Solved problems timely and effectively, ensuring customer satisfaction.
- Collaborated with other departments to foster smooth operation of daily processes.
- Monitored and updated inventory levels and maintained accurate records of inventory and stock movements.
- Managed day-to-day department operations with effective workflow coordination.
- Trained and supervised employees on office policies and procedures.
- Increased customer service success rates by quickly resolving issues.
Education
Certificate - Certified Revenue Cycle Specialst
American Association of Healthcare Administration
Online03-2024
High School Diploma -
Silver High School
Silver City, NM05-2010
Skills
- Complex claims consulting
- Documentation review
- Forms validation
- Claims trend analysis
- Claims
- Claims investigation
- Verbal communication
- Claims analysis
- Microsoft office
- Claims processing
- Adjustment Review
- Team Leadership
- Training New Employees
Certification
- Certified Revenue Cycle Specialist
Timeline
Senior Patient Claims Specialist
Gerald Champion Regional Medical Center
04.2023 - Current
Patient Financial Specialist
Gerald Champion Regional Medical Center
03.2022 - 04.2023
Patient Access Representative
Gerald Champion Regional Medical Center
06.2021 - 02.2022
Hospitality Specialist
Gerald Champion Regional Medical Center
02.2018 - 06.2021
Operations Assistant
NAF
06.2016 - 05.2018
Certificate - Certified Revenue Cycle Specialst
American Association of Healthcare Administration
High School Diploma -
Silver High School
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