Patricia M. Lopez

**** ******* *****

Spring, TX 77379

Mobile: 562-***-****

Email: acx2ih@r.postjobfree.com

Specialize in numerous administrative skills with strong communication in medical terminology. Committed to working as a team player with over twenty years of excellent customer service in collaborating with patients, members, and providers.

EDUCATION

Foy H. Moody High School - 1978

Corpus Christi, Texas

Academy of Health Care Professionals - 1997

Medical Billing and Anatomy Certification

Houston, Texas

EMPLOYMENT HISTORY

Texas Children’s Health Plan December 2008 – August 2016

Provider Relations Representative

Successfully trained internal provider relations managers, call center team, and external providers

Volunteered at community events such as Kids Fit, Back to School, Kids Fun Run

Developed and updated training materials and as required and needed.

Provide education and assisted on billing and claim related issues on provider portal.

Point of contact for professional and facility providers on more complex high touch issues

Responsible for the protection of personal health information of our members and providers

Report HIPAA violations to our Controls and Compliance Department on a monthly basis

Texas Children’s Health Plan October 2000 – December 2008

Member Services Team Leader

Investigate member issues for resolutions assisted providers regarding claims issues

Provided education to our member regarding their benefits in English or Spanish if needed

Created all training materials to educate member services staff

Supported the call center daily with complex issues or high call volume

Monitor calls for quality measures.

Participated in Health Fairs to assist communities with education of State programs.

Mario O. Kapusta, M.D. - Cardiac and Thoracic Surgery March 1999 – October 2000

Administrative-Reimbursement Coordinator

Filed medical billing, paper and electronic claims; appealed claims.

Transcribed cardiology operative reports to file with Memorial Hermann Hospital

Coordinated all of doctor’s hospital visits and handled credentialing for all facilities

Managed calendar of appointments, surgeries, CME’s, and meetings

. Collected on outstanding accounts and applied adjustments as needed

Humberto J. Lacayo, M.D. – Internal Medicine – Family Practice March 1997 – March 1999

Office Manager

Trained and managed front desk and billing staff

Arranged on site review with health plans for credentialing

Interviewed new employees for hiring of several positions

Filed Medical billing on HCFA 1500, UB forms, and electronic also handled aged collections

Skills and Abilities: Microsoft Word, Excel, PowerPoint, Microsoft Outlook, Notary Public since 1996, Bilingual in Spanish, able to multi-task and exercise good judgement and discretion in decision making.

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