Customer Service Patient Services

DARLING GUTIERREZ

770-***-**** **** Alhambra Crest Drive, Ruskin, GL 33570 ******************@*****.***

CAREER SUMMARY

Dedicated and highly organized professional with a strong background in medical customer service, patient services, and administrative support. Proven ability to deliver exceptional service to patients, manage administrative tasks efficiently, and ensure smooth healthcare operations. Skilled in addressing patient inquiries, maintaining accurate records, and collaborating with healthcare teams to optimize patient experiences. Committed to upholding the highest standards of confidentiality, accuracy, and professionalism in all aspects of medical administration and patient service.

AREAS OF EXPERTISE

Microsoft Office Medical Terminology HIPAA Insurance

Reports/Documentation Patient Services Electronic Health Records Billing Remote/WFH

Payment Processing Scheduling Organizational Skills Team Leader Key Performance Metrics

Call Management Claims Processing Medicare/Medicaid Quality Assurance Patient Privacy

Interpersonal Skills Verbal/Written Communication Skills Benefits

TECHNICAL SKILLS: EPIC/CENTRICITY/ARTIVA

PROFESSIONAL EXPERIENCE

Patient Advocate August 2019-Current

Change Healthcare (CMD/Marshal/Optum of Mexico/University of Texas Physicians)

Serve as an intermediary connecting patients, families, and healthcare professionals to ensure effective communication.

Educate patients about their rights, obligations, and the array of resources available within the healthcare framework.

Collaborate closely with team to address patient inquiries, enhance care coordination, and elevate the overall patient experience.

Facilitate open and respectful communication between patients and their healthcare providers.

Guide patients through the complexities of insurance claims and coverage details.

Thoroughly document patient interactions, concerns, and issue resolutions in electronic health records (EHR) systems.

Extend emotional support and provide resources to patients and their families during challenging and distressing circumstances.

Customer Service Representative

Proficient in medical terminology, insurance verification, and appointment scheduling.

Demonstrated strong knowledge of HIPAA regulations and patient privacy.

Served as the initial point of contact for patients, providing friendly and empathetic assistance.

Scheduled patient appointments, verified insurance coverage, and explained billing procedures.

Addressed patient inquiries and concerns via phone, email, and in-person interactions.

Collaborated with clinical staff to ensure a seamless patient experience.

Assisted patients in accessing their medical records and navigating the electronic health records (EHR) system.

Maintained confidentiality and adhered to HIPAA regulations when handling patient information.

Provided accurate information regarding medical services, test results, and prescription inquiries.

Resolved patient issues promptly and escalated complex cases to the appropriate department.

Consistently met and exceeded performance metrics for call quality and patient satisfaction.

Front Desk Assistant February 2014-September 2014

Orthodontics Care of Georgia

Greeted and communicated with patients and insurance providers, copying and faxing documents, collecting cash and credit

card payments, running end of day reports and making sure that cash, insurance, and credit card payments balance.

Performed necessary duties associated with checking patients in and out.

Recorded treatment information in the patient’s chart.

Completed all end of day accounting and production reporting, collects fees and records as needed; oversee referrals to other

dental offices and quickly responded to all patient requests or inquiries.

Coordinated patient information through all caregivers, insurance companies, billing departments, and according to facilities

policies and procedures.

Job Title: Medical Records Specialist November 2009-December 2013

Gwinnett Pulmonary

Oversaw the organization and maintenance of medical records for Gwinnett Pulmonary.

Ensured the accuracy, completeness, and confidentiality of patient records.

Processed requests for medical records in compliance with HIPAA regulations.

Collaborated with healthcare providers to retrieve and update patient information.

Conducted regular audits of medical records to identify discrepancies and ensure compliance.

Trained new staff members on medical records management procedures.

Assisted in transitioning from paper-based records to electronic health records (EHR) system.

Job Title: Back Office Appointment Scheduler November 2009-December 2013

Gwinnett Pulmonary

Managed back end office operations in areas of manual and computerized scheduling, billing and medical/insurance records

management, including major carriers and Medicaid.

Optimized patients' satisfaction, provider time, and treatment room utilization by scheduling appointments in person or by

telephone.

Registered patients according to practice protocols, determining the financial status of patients and their eligibility for medical

services.

Responsible for scheduling appointments, keeps patient's information updated in computer at all times, performs other clerical

duties as needed.

Updated demographic and insurance information to ensure appropriate and timely claims processing and patient billing.

Respected and maintained the privacy of agency clients, assuring client confidentiality at all times. patients' rights

Verified the insurance eligibility and health care coverage of the patients before services are provided.

Job Title: Pediatric Scheduler January 1999-August 2003

Nanston Dental

Schedule and coordinate appointments for pediatric patients, ensuring convenient and timely access to healthcare services.

Collect and verify patient information, including personal details, insurance coverage, and medical history.

Communicate with parents or guardians to gather necessary information, address inquiries, and confirm appointment details.

Collaborate with healthcare providers, nurses, and support staff to optimize the clinic's appointment schedule, minimizing wait times and maximizing efficiency.

Maintain accurate and organized patient records in compliance with healthcare regulations and clinic policies.

Manage incoming phone calls and email inquiries, providing exceptional customer service and resolving scheduling-related issues promptly.

Uphold strict patient confidentiality and privacy standards, adhering to HIPAA regulations.

Job Title: Claims Processor January 1999-August 2003

Nanston Dental

Reviewed and verified patient insurance information, including coverage, deductibles, and benefit limits.

Processed dental insurance claims for a variety of procedures, ensuring accurate coding and documentation.

Investigated and resolved any claim discrepancies or rejections promptly.

Communicated with insurance companies to track claim status and resolve outstanding issues.

Assisted patients with insurance-related inquiries and provided explanations of benefits (EOB).

Maintained up-to-date knowledge of dental codes and insurance regulations.

Collaborated with the billing department to ensure accurate patient billing.

EDUCATION

GEORGIA STATE UNIVERSITY

ASSOCIATES IN BUSINESS ADMINISTRATION/2020

ENGLEWOOD ADULT HIGH SCHOOL

HIGH SCHOOL DIPLOMA

Contact this candidate