Xiomara Diaz
Poughkeepsie,NY
Summary
Motivated Healthcare Specialist with experience successfully managing and monitoring eligibility information for members and groups. Highly skilled at facilitating program approval or denial through qualifications assessment, fact checking and record keeping. Confident and committed to promoting positive customer outcomes through dynamic communication and exemplary engagement skills. Medical Biller and coder with eye for detail and commitment to accurate work. Supportive Eligibility Specialist with extensive application engagement and dedicated service skills. Bilingual professional in English/Spanish with skill to maintain accurate records, schedule appointments and handle various administrative responsibilities.
Overview
10
10
years of professional experience
Work History
Customer Service Representative
Independent Health
Williamsville , NY
09.2021 - Current
- Used knowledge of CPT codes to look up member benefits and claim inquiries
- Analyze claims and send off for adjustment or review when appropriate
- Ability to determine claim status and when claim is adjudicated properly
- Explain to members how claims are billed based on CPT codes and diagnosis codes
- Address needs and utilized tools and resources to address and resolve inquiries
- Followed appropriate escalation procedures when appropriate
- Provide excellent customer service when responding to members
- Maintain knowledge regarding health contracts and benefits, policies and procedures
- Follow HIPAA policy and procedures
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Healthcare Authorization Specialist
Fidelis
Getzville, NY
03.2020
- Data entry of authorization requests -Reaching out via phone to both members/providers -Documenting data in Facets and inputting authorizations -Scanning documents into their system from paper copies -Triaging electronic faxes and routing them to the appropriate area for review.
Medicaid Enrollment Processor
Univera Healthcare
Amherst, NY
10.2019 - 01.2020
- Processing PCP (provider) updates to member accounts from email requests.
- Logging into the email system and membership system -Opening PDFs with member provider update requests and making the requested update to member account.
- Facets Lock Box Data entry Specialist.
Data Entry Specialist
M&T Bank
Amherst, NY
09.2019 - 09.2019
- Open and prepare deposits for processing using customer specific documented instructions -Key deposit batch information into Lockbox application -Capture check and document images utilizing high-speed imaging equipment -Complete data entry based on customer specific documented instructions -Complete check keying including dollar amounts and MICR line information -Process credit card transactions utilizing merchant services application -Review and prepare completed deposits for return to customer -Prepare, balance and send customer data transmissions -Understand and adhere to the Company's risk and regulatory standards, policies and controls in accordance with the Company's Risk Appetite -Identify risk-related issues needing escalation to management.
Data Entry Specialist
Citi
Getzville, NY
01.2019 - 06.2019
- Accurate, fast keying skills -Knowledge of computer applications -Proven ability to collect and manage information efficiently and accurately -Maintain Confidentiality -Input confidential information -Adhere to company’s risk and regulatory standards, policies and guidelines.
Corps Commanding Officer/Administrator
The Salvation Army
Spring Valley, NY
06.2010 - 06.2018
- Responsible for managing and coordinating all department functions with a team of 15 employees and 10 volunteers.
- Departments include: Social Services, Afterschool programs, Soup kitchen, Food pantry.
- Serving 500+ clients weekly; supervised client needs to determine necessary services and make appropriate treatment recommendations.
- Represented agency at meetings and conferences.
- Coordinate programs and staff.
- Made reports and kept inventory and budgeted for facility needs.
- Other duties applied: -Greet Clients -Data entry -Maintained computer and manual filing systems -Coordinate office procedures -Reply to emails -Develop and update administrative systems to make them more efficient Handle sensitive information in a confidential manner -Write letters and emails on behalf of other office staff -Filing and maintain records -Produce and distribute correspondence memos, letters, faxes and forms Preparation of regularly scheduled reports -Develop and maintain a filing system -Order office supplies -Educated families and community members -Maintain Inventory -Coordinate/Supervised Programs and Staff Receptionist and Call Center.
Education
Medical Billing & Coding Diploma -
Penn Foster
A.A.S - Occupational Studies
Salvation Army College for Officer Training
Medical Office Administrative Assistant Courses - undefined
Bergen Community College
Skills
- Facets program software
- ICD 10
- HIPAA
- Medical Terminology
- Anatomy & Physiology
- Excel
- Typing 60wpm
- Excellent Office Administration Skills
- Call Center
- Customer Service
- Data entry
- Microsoft Office
- Excellent Office skills
- Organizational Skills
- Effective communication skills
- Resource information
- Appointment Scheduling
- Medical Coding Knowledge
- Medical Billing
Timeline
Customer Service Representative
Independent Health
09.2021 - Current
Healthcare Authorization Specialist
Fidelis
03.2020
Medicaid Enrollment Processor
Univera Healthcare
10.2019 - 01.2020
Data Entry Specialist
M&T Bank
09.2019 - 09.2019
Data Entry Specialist
Citi
01.2019 - 06.2019
Corps Commanding Officer/Administrator
The Salvation Army
06.2010 - 06.2018
Medical Billing & Coding Diploma -
Penn Foster
A.A.S - Occupational Studies
Salvation Army College for Officer Training
Medical Office Administrative Assistant Courses - undefined
Bergen Community College
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