Customer Service Revenue Cycle
Resume:
ZULEMA GUZMAN
************@*****.***
OBJECTIVE
Seeking a fulfilling career opportunity where I can leverage my extensive experience in healthcare revenue cycle management, supported by formal academic training and a lifelong commitment to the human services field. Over the course of my career, I have held diverse roles including Patient Advocate, Benefits Counselor, Ombudsman, Case Manager, Medical Service Consultant, and Community Healthcare Worker, consistently coordinating and managing care for individuals with complex health need.
SKILLS
• Healthcare reimbursement, charge entry, appeals, eligibility verification, case management
• Medical terminology, ICD-9/10, CPT, HCPCS coding
• Insurance knowledge: Medicare, Medicaid, Commercial, VA, Third-Party Payers
• EHR: Cerner, Paragon, Billing Software: Medisoft, Insurance Portals Availity, TMHP, Novita’s, UHC, Molina, etc.
• Bilingual: English/Spanish; Call center (inbound/outbound); Customer service
• Typing speed: 50 WPM
• Software: Microsoft Word, Excel, Outlook, Teams, Zoom
• Standard office equipment: Fax, phones, copier
EXPERIENCE
09/2023 – 10/2024
Independent Insurance Consultant, Self Employed Weslaco, TX. Licensed Insurance Agent & Independent Consultant focused on expanding my book of business through strategic multi-platform marketing. Specializing in providing guidance towards the best insurance solution for their healthcare needs. Educating on Medicare Part A, B, C, D and Medicaid, MCO, HMO. 10/2022 – 05/2023
Business Office Specialist, DHR Health McAllen, TX. Experienced in a wide range of business office functions, including accounts receivable collections, patient billing, customer service, processing refunds and handling appeals and reversals for services provided to patients and third-party payers. Proficient in posting charges, verifying insurance eligibility, and supporting overall revenue cycle operations."
01/2020 – 07/2022
Business Office Specialist, DHR Health McAllen, TX. Experienced in a wide range of business office functions, including accounts receivable collections, patient billing, customer service, processing refunds and handling appeals and reversals for services provided to patients and third-party payers. Proficient in posting charges, verifying insurance eligibility, and supporting overall revenue cycle operations."
2017 – 2021
Installer/Technician
Independent Contractor with Critical Systems Technology as an installer of Medical Device of Personal Emergency Response Systems (PERS) in the South Texas Region. Drove to client’s home and installed their life alert systems. Completed administrative duties by obtaining client demographics, assessment. Installed and tested device at client home.
08/2017 – 12/2019
Independent General Lines Agent in Life, Accident, Health & HMO Became a producer for BCBS, Cigna Healthspring, Superior AllWell, United Healthcare Group. Advised community clients in the navigation of Medicare Advantage products by guiding them towards the best insurance solutions for their healthcare needs.
07/2016 – 02/2017
Community Health Worker, Driscoll Health Plan McAllen, TX. Experience in supporting maximizing the member’s health, well-being and independence. Assisted the Disease Management program in conjunction with the DM Health Coach/Service Coordinator with a person -centered planning to prevent, delay or reduce the progression of chronic conditions and the need for institutionalization and to maintain the member safely in the community. In providing health and self- management and sufficiency education regarding the member’s health and self-management and sufficiency education regarding the members particular healthcare needs via telephonically or home visit. 03/2012 – 12/2012
Patient Advocate TX CHIP, Delta Dental of California- Remote Staff Experience direct case management of plan members, assist with coordination of services, educate members regarding dental health issues, plan benefits, claims issues, complaints, grievances and appeals. Provided independent professional and analytical support focusing on clinical analysis and evaluation of applicable dental services. Researched and responded to patient/provider telephone, electronic, or written inquiries and documented, tracks, adjudicated and obtain assistance for patients eligible for dental benefits.
11/2008 – 02/2012
Medical Service Consultant, Affiliated Computer Service, INC. TMHP, Remote Staff Experience direct case management and health education services to eligible Medicaid clients in a cost- effective manner. Frequent follow-up with client population. Performed assessment, developed and implemented individualized client plan of care in collaboration with client/family and primary care providers/specialist. Provided independent professional and analytical support focusing on clinical analysis and evaluation of applicable medical services. Maintained appropriate documentation and support for all activities. Functioned as project lead providing status reports to management team. 10/2004 – 09/2007
Case Manager, LRGVDC Area Agency on Aging, McAllen, TX. Experience in the ongoing basis Case Management services for older persons or eligible persons. Duties include gathering information, identifying appropriate services, writing a comprehensive plan of care, approves delivery of services as specified in the services plan and monitoring the delivery of services to elderly persons. Telephonically or via home visits for the three counties Willacy, Cameron and Hidalgo. 04/2003 – 09/2004
TECH III, LRGVDC Area Agency on Aging, McAllen, TX. Experience in the ongoing basis Case Management services for older persons or eligible persons. Duties include gathering information, identifying appropriate services, writing a comprehensive plan of care, approves delivery of services as specified in the services plan and monitoring the delivery of services to elderly persons. Telephonically for the three counties Willacy, Cameron and Hidalgo. 09/2001 – 03/2003
TECH II Ombudsman, LRGVDC Area Agency on Aging, McAllen, TX. Experience in supporting the Nursing Home Ombudsman Program, including serving as a liaison between nursing homes and their residents and families, and Volunteer Ombudsman/Friendly Visitors. Additional activities include recruiting volunteers, training volunteers, and monitoring licensed and un licensed care homes and boarding homes. Maintained contact with residents, family, and organizations of elderly, representatives of state agencies, private contractors, and the general public. 07/2000 – 09/2001
TECH I Information & Assistance, LRGVDC Area Agency on Aging, McAllen, TX. Experience in providing clients with consistent advocacy offering necessary information and assistance to assure continued independence, and brokering services by identifying appropriate services and monitoring delivery of services to the elder persons and maintaining documentation of expenditures. Maintained contact with client, family, public and private agencies and organizations, service providers and general public.
09/1997 – 06/2000
Information & Assistance Specialist, LRGVDC Area Agency on Aging, McAllen, TX. Experience in providing clients with consistent advocacy offering necessary information and assistance to assure continued independence, and brokering services by identifying appropriate services and monitoring delivery of services to the elder persons and maintaining documentation of expenditures. Maintained contact with client, family, public and private agencies and organizations, service providers and general public.
EDUCATION
01/15/2019 – 08/08/2019 Valley Grande Institute, Weslaco, TX. Medical Insurance Coder and Billing Technician Program Certificate Program Units 665/GPA 3.91
06/1994 – 05/1995 South Texas College, McAllen, TX. Medical Information Specialist, Nursing and Allied Health Program Certificate Institution hours 66/GPA 3.63
09/1985 - 05/1989 Donna High School Donna, Texas
Contact this candidate