Customer Service Insurance

**** ***** ***.

League City, TX *****

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********.*****@*****.***

Misty Marie Martinez

Objective

To obtain a challenging career that will enable me to grow personally and professionally.

Experience

2011-2012 Texas Children’s Hospital Houston, TX

Lead Ambulatory Service Rep - Academic General Pediatrics Perform patient registration procedures; ensure patient forms are provided and filled out for the visit; communicate patient arrivals, delays and clinic processes; alert staff and providers of any changes or discrepancies in patient's appointment; refer patients with inadequate funding to the financial counselor; maintain an organized filing system of referrals in progress and communicate all missed appointments to PCP; review new referrals with provider; review provider schedule for open slots schedule patients; assist licensed staff with non-financial aspects of the inpatient admission process (calls escort, helping with paperwork, etc.); perform closing procedures (reconciling fee receipts, completing deposit notification forms, reconciling petty cash, balancing the credit card machines, completing batch reports, making deposits). Obtain and verify patient demographic data; collect for non pre-admitted services; verify insurance benefits and identify plan codes; initiate investigation into variances; collect up-front fees; resolve patient account problems; confirm receipt of insurance referrals; follow up on payor specific accounts pending authorization; serve as clinic/family resource regarding managed care questions. Schedule new or follow-up appointments; advise of insurance responsibilities; schedule ancillary appointments and diagnostic tests; direct patient to next appointment; create, change and coordinate provider master schedules/templates for new and existing providers; coordinate rescheduling of bumped patients. Charge entry and reconciliation. Ensure interpreter services are available for patients as needed; welcome and interact with patients, families and visitors in a professional, timely, age appropriate and culturally sensitive manner; respond to customer questions; proactively approach dissatisfied customers and implement customer service recovery measures; assist with marketing of the department to walk-in prospective customers/visitors. Perform assignment of "in-charge" employee in the absence of the supervisor.

2006-2011 Texas Children’s Hospital Houston, TX

Health Center’s Coordinator

Effectively coordinate the daily operations of a Health Center in order to maximize patient flow, internal and external costumer expectations and patient satisfaction. Assist several LEAD ASR’s with their reports on a weekly basis as well as assist other ASR’S remain on task by helping complete work that may be behind. This included travel to the appropriate Health Centers. Formed the flow for the front desk when the new Clear Lake Heath Center opened in 2006; which is still in use today. Train new hires. Ensure a smooth practice site operation, including but not limited to equipment and supplies ordering, handling physician/patient concerns and statistical reporting including reconciliation. Secure the financial integrity of each account generated to maximize reimbursement, verification of insurance by reviewing all contractual requirements of managed care and insurance companies, appointment scheduling, financial counseling and collections to include payment agreements. I suggested and implemented our current process for pre-admits; studied the pt volumes and divided up the days to equal work loads. Responsible for creating master schedules as well as monitoring and changing daily schedules to avoid physician down time in the IDX system. Created monthly schedule as well as complete monthly stat report. Have been accountable for all order entry charges for ancillary testing and procedures to be performed at the Health Center or outside entity. Act as a liaison for all services participating at the Health Centers as well as all referring physicians offices.

2003-2006 Texas Children’s Hospital Houston, TX

Centralized Scheduling and Registration Rep.

Handle incoming requests from patients and physicians for provider appointments, while securing the financial integrity of each account generated to maximize reimbursements, including meeting any and all contractual requirements of managed care companies (pre-certification, referrals, authorizations, etc.) Educate and communicate to patient families or responsible parties arrival times, how to cancel and reschedule an appointment, and all other necessary information to streamline the process or patient arrival in clinic. Ensure the hospital is in compliance with state or federal regulations applicable in the admissions settings. Train new hires the CSR process. Master Scheduler. In charge of handling requests to transfer out patients to in patients in the IDX system, and begin pre-certification for the transfer. Education 2003 University of Houston Houston, TX

B.S. Health

2013 Lamar Institute of Technology Online

Realtor - License # 629812

Skills Knowledge of medical terminology, insurance terminology and customer service concepts. The ability to communicate effectively, good interpersonal skills, organization and problem solving skills, good time management skills, excellent customer service skills, operate a personal computer and software efficiently and operate general clinic equipment. Self-initiated work behaviors.

Office

Bilingual,Nextech, HAR, MLS, Zillow, Trulia, Linkdin, Dot Loop, Paperless Pipeline. Patient Pad, EPIC, Misys, Medisoft Computerized Insurance Billing, Claim Processing, Claim Examination, Medicaid, Medicare Billing, Commercial and Private Insurance Billing, HCFA 1500, CPT and ICD-9 Coding, Insurance Verification, Microsoft Word, Excel, Reception Duties, Scheduling. Supervised, trained coworkers. Patient Check-in/Out, Filing and Medical Transcription, IDX, PWL, Decmed, Logician.

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