Medical Billing Customer Service

MELODY VALDEZ

929-***-**** New York City, NY ******.*********@*****.*** Linkedin

Healthcare Professional with 7 years of experience in patient accounts, patient advocacy, community-based care, medical navigation, project management, data analysis and quality assurance. Proficient in maintaining medical records and knowledgeable in medical terminology. Experienced in medical billing for Medicare, Medicaid, and private insurance. Knowledge of HIPAA laws and regulations as it relates to release of patient information. Skilled at building successful relationships with cross-functional teams, patients, and internal staff to provide exceptional customer service. Experience working as a telecommuter for 5 years with minimal supervision.

Areas of Expertise:

Administrative Support Business Communication Community Engagement Conflict Resolution Contact Tracing Customer Service Data Analysis Healthcare Insurance HIV Knowledge Medicaid and Medicare Mental Health Project Management Quality Assurance Substance Abuse Workflow Management

Relevant Experience:

Evolent Health (Remote) 2021 - current

Care Coordinator

Communicate with providers to coordinate appointments and home care support.

Perform light touch interviews and educate members about community services to identify those that qualify for care management programs.

Assigned cases to appropriate team members.

Review medical records for PHI and ensure patient information is correct.

Verify member eligibility and increase adherence to the program through coordination with assigned physician.

Strategize and consult with an internal team of RNs, Health workers and Behavioral case managers regarding patient care and served as the contact point.

Met productivity, performance expectations and trained new Care Coordinators/ RNs on CRM in my initial 90-day probationary period.

Extra Duties: Assisted UM department in outreaching to providers/members about approval authorization notices. Assisted in UM call center inbound calls from providers, members, home care agencies etc.

New York City Health + Hospitals, Test & Trace Corps, (Remote) 2020 – 2021

Community Engagement Specialist

Built and managed key partnerships with partners and contractors on the administration of the program, ensuring compliance with regulations to mitigate and curb the spread of COVID-19 in New York City.

Assisted the Program Administrator with the planning of enrollment campaigns and community outreach events.

Provided supportive services & referrals to 25+ cases weekly to promote effective quarantine & isolation practices to reduce the mortality and morbidity rates of COVID-19 locally.

Maintained quality assurance to promote best public health practices internally & with clients for maximal efficiency and effectiveness in an unprecedented public health emergency.

United Healthcare, (Remote) 2017 – 2019

STARS Member Navigator

Confirmed HMO healthcare for all 300+ clients to verify service pre-certification, insurance coverage and personal responsibility.

Conducted outreach & maintained public relations w/ 300+ Medicaid/Medicare clients for care guidance

Provided transitionary care services to promote engagement with primary care doctors.

Utilized home visits to conduct HRA assessments, provide education of services and schedule appointments for clients.

Developed & maintained relationships with clients & created new contracts for organizational development purposes.

VIP Community Services & Health Home, Bronx, NY 2016 – 2017

Clinical Care Coordinator

Responded to office emails, scheduled, and confirmed appointments as well as answered multi line phone system.

Checked patients in and out, collected and verified insurance information as well as obtained necessary insurance authorizations.

Scanned all paperwork into EMR system and converted hard copy patient records to EMR

Conducted screenings, workload assessments, & devised new operational processes that led up to 40-50% increase in productivity.

Additional Experience:

Patient Care Navigator, Hope Care Management & Health Home, Bronx, NY 2014 – 2016

Education:

Bachelor of Arts, John Jay College of Criminal Justice, City University of New York, 2013

Technical Skills:

EMR/EHR: Crimson, AllScripts CRM: SalesForce, RedCap, CareOne, ICUE, E Clinical Works, Identifi Claims: ePACES, FACETS Office: Microsoft Office, SharePointe

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