ZAIRA ZAVALETA
Access Family Care
Carthage,MO
17
years of professional experience
Proven healthcare operations leader skilled in enhancing team performance and operational efficiency while ensuring compliance with Medicare and Medicaid. Experienced in staff supervision, developing training initiatives, and creating policies that streamline processes and improve service quality. Bilingual in English and Spanish, with a Bachelor of Science in Management, focused on achieving targets in fast-paced environments.
Work History
Benefits Enrollment Specialist
1 Year 8 Months- Assisted in reviewing public assistance programs such as Medicaid and unemployment benefits by examining procedures and recording findings for stakeholders.
- Supported team leaders in coordinating tasks across benefit areas while monitoring team member contributions.
- Facilitated benefits enrollment process for diverse client populations.
- Collaborated with cross-functional teams to streamline enrollment procedures.
- Analyzed client data to ensure accuracy in benefits selection and processing.
Revenue Operation Specialist
1 Year 8 Months- Led onboarding for new employees, successfully preparing 20 team members for their roles through structured orientation and training.
- Trained employees on third-party payer systems and multiple electronic health record (EHR) platforms, including Epic, Meditech, Facilitator, and EWR, to ensure proficiency in claims processing.
- Streamlined operational processes to enhance efficiency and reduce waste.
- Analyzed workflow to identify areas for improvement and implement solutions.
- Developed training materials for new hires, improving onboarding experience and retention rates.
- Served as a subject-matter expert on Medicaid eligibility, billing, and reimbursement requirements for 10 states, providing support to cross-functional teams on compliance and processes.
- Trained employees on third-party payer systems and multiple electronic health record (EHR) platforms, including Epic, Meditech, Facilitator, and EWR.
- Advised third-party organizations on compliant claims submission practices, resulting in reduced denials and improved payment outcomes.
- Led onboarding for new employees, successfully preparing 12 team members for their roles through structured orientation and training.
Team Lead
4 Years 10 Months- Supervised and coached team of six employees, delivering leadership and performance guidance to enhance team effectiveness.
- Directed daily operations of Medicaid-funded disability services, maintaining compliance with state and federal regulations to ensure service integrity.
- Designed and implemented a structured training program that increased new hire productivity by 25%.
- Directed daily operations of Medicaid-funded disability services, ensuring compliance with state and federal regulations.
- Collaborated with team of 5 leaders to identify workflow challenges and implement process improvements, achieving 15% increase in service quality.
- Managed escalations for over 50 complex cases per month, resulting in a 15% reduction in resolution times for operational issues.
Senior Customer Services Representative
5 Years 10 Months- Assisted 100+ members and providers monthly with dental benefits, eligibility, billing, claims, and policy inquiries using CRM software, enhancing customer support experience.
- Investigated and resolved complex claims, payment discrepancies, and benefit determinations while maintaining compliance with HIPAA and company policies.
- Conducted training sessions for 50+ providers and 100 members on insurance benefits and claims procedures, increasing clarity and confidence in claims processes.
- Trained and mentored 10+ new employees while resolving escalated customer concerns, contributing to a 20% increase in customer satisfaction ratings.
- Conducted training sessions for over 50 providers and 100 members on insurance benefits and claims procedures, improving understanding of claims processes.
Education
Bachelor of Science - Management
- Member, Delta Mu Delta Honor Society
- President's List
Associate of Science - Accounting
- Awarded Member, National Society of Leadership and Success
Certificate of Technical Studies - Medical Assistant
Skills
Benefits management
Claims investigation
Compliance Monitoring
Documentation review
Data Analysis
Process Improvement
Operational Planning
Complex Case Resolution
Cross-Functional Collaboration
Problem resolution
Analytical Decision-Making
Effective communication
Attention to detail
Timeline
Benefits Enrollment Specialist
Access Family Care
12.2024 - CurrentRead More
Revenue Operation Specialist
E-ONE
04.2024 - 12.2025Read More
Team Lead
E-ONE
06.2019 - 04.2024Read More
Senior Customer Services Representative
United Concordia Dental
11.2009 - 09.2015Read More
Colorado Technical University
Bachelor of Science from Management
Read More
Colorado Technical University
Associate of Science from Accounting
Read More
Kaplan Career Institute
Certificate of Technical Studies from Medical Assistant
Read More