Resume

Nursing Assistant Service

Location:

Harlingen, TX

Posted:

August 16, 2022

Contact this candidate

Resume:

Melisa Martinez

P.O. Box ***

Rio Hondo, TX *****

Phone: 956-***-****

Objective:

Qualified candidate with a diverse array of skills, seeking a position with a healthcare organization or agency, who values the team concept, delivers quality care, and willing to benefit from my expertise.

Experience:

TriWest Healthcare Alliance

Harlingen Texas August 2019 – Present

Outbound Patient Service Representative (Work from Home) Assisted veterans with scheduling appointments for new consults and continuation of care with community providers. Used resources to find provider that is closest to the veteran that could provide care according to referral submitted in by the VA. Analyzed information from VA referral to determine what type of care is needed for the veteran and type of provider that would be able to provide the requested services. Faxed authorization information and medical documentation to providers’ offices for review. Followed up with provider for status to ensure timely appointing. Assisted management with special projects, such as updating ER Authorizations with correct data for billing purposes, also assists with collecting veteran preferences for services. Worked independently with minimal supervision. Maintained HIPPA compliance and ensured veteran’s safety standards. Verified provider and veteran information to maintain up to date records. Care Coordination Assistant (Embedded at Harlingen VA: 2106 Treasure Hills Blvd Harlingen, TX

78550) August 26, 2019- January 13, 2019

Worked alongside VA Community Care Advocates as an embedded staff member. Served as a front-line contact for veterans and VA staff to assist with questions and concerns regarding authorizations, appointments with community providers, and bills from community providers. Used compassion and patience when explaining processes and answering questions. Maintained the VA’s safety standards for veterans by requiring two forms of identification before disclosing veteran information. Worked on Escalation emails from the Harlingen VA. Processed and appointed

authorizations as part of the High-Performance Network, utilizing the TriWest navigators at Harlingen Medical Center and Doctors Hospital at Renaissance. Assisted live veterans with questions regarding the process for authorizations and appointing. Assisted veterans and VA staff with issues regarding claims and billing. Scheduled appointments with community providers for veterans. Processed referrals submitted by the VA to build authorizations. Escalated bills to TriWest’s claims department.

Health Success Therapy

Harlingen Texas 2007-August 2019

Medical Billing Specialist: Work with Medisoft software and Re- doc. I bill all manage care insurance (Superior, Molina, Driscoll and United Healthcare) I'm responsible for all the aging reports for the insurance and collections. I'm responsible for doing all the billing and re-billing for the insurance mentioned above, posting all insurance payment and adjustments into the system, and to obtain the authorizations for the evaluations and treatments. I also answer phones on a timely manner and take phone referrals from Dr. Offices or from patients, I call to confirm appointments on the day of the appointments. I'm responsible for all medical records request from SSI, doctor offices, lawyers.

Schaller Anderson of Texas LLP dba Valley Baptist Medical Harlingen Texas 2007-2007

Prior Authorization Representative: Working with the Medical Management Department, my role consisted of processing medical reviews, prior authorizations, and special medication requests. This involves preparing them through research, knowledge and application of health plan policies and procedures, Texas Department of Insurance (TDI) laws and regulations and presenting them to the Chief Medical Officer. In addition, I maintain logs and spreadsheets that are crucial to daily operations and audits for both CMS and TDI. I am an integral team member involved in the preliminary appeals process, processing denials correctly and generating the denial letters to the clients, providers, and members. My responsibilities include conducting credentialing site visits with physicians and other health plan providers. I am direct support to the Director of Medical Management.

Valley Baptist Medical Center

Harlingen, Texas 2005 – 2007

Outpatient Scheduler: This role consisted of scheduling all outpatient radiological procedures, including Special Procedures, Interventional Radiology, and imaging, for a large Level I Trauma Center. My role included receiving physician orders, scheduling appointments, and educating patients, families, and physician providers, regarding the necessary information related to the procedure(s) involved.

Rio Grande Medicine

Harlingen, Texas 2001 - 2004

Medical Biller: Employed by a physician group practice, my responsibilities included screening billing reports for Commercial insurance, Medicare, and Medicaid. In addition, I was responsible for maintaining claim files and assisted with billing collections. Rio Grande State Center

Harlingen, Texas 1993 - 1998

MHMR Service Assistant: Employed as a Mental Health Service Assistant, I assisted mentally challenged residents with their activities of daily living (ADL's). In this role I also assisted in caring for the environmental needs of the clients and managed progress report files.

Retama Manor

Harlingen, Texas 1992 - 1993

Certified Nursing Assistant: Working as a Certified Nursing Assistant, this position involved every aspect of patient and resident care, including caring for the ADL's of them. This role required me to hold a nursing assistant certification from the Texas Board of Nurse Examiner's.

SKILLS:

• Typing Microsoft Word

• Microsoft Excel Business

• Math/10 key

• Medical Terminology

• Medical Office

Procedures

• Medical Insurance Forms

• CPT-Coding and ICD-10

• Coding Scheduler

• PRN Scheduling

EDUCATION: