Maricela Deleon
Bullhead City
Summary
Bilingual Spanish Professional with extensive experience in managing appeals processes within healthcare sector. Known for strong analytical skills, effective communication, and ability to navigate complex regulatory environments. Proven track record in fostering team collaboration, adapting to changing requirements, and achieving results. Well-versed in conflict resolution, data analysis, and workflow optimization. Reliable and adaptable with focus on delivering high-quality outcomes.
Overview
13
13
years of professional experience
Work History
Denials/Appeals Coordinator
Kingman Regional Medical Center
Kingman, AZ
04.2025 - Current
- Managed communication between patients, insurance providers, and internal departments to facilitate claim approvals.
- Analyzed complex cases to identify trends and improve appeal strategies for better outcomes.
- Developed comprehensive documentation for appeals, adhering to regulatory requirements and best practices.
- Coordinated appeals process to ensure timely resolution of patient claims and disputes.
- Led initiatives to streamline workflows and enhance efficiency in the appeals process across departments.
- Conducted regular audits of appeal cases to ensure accuracy and compliance with industry standards.
Admissions & Collections Clerk
Riverside University Health System
Riverside, CA
02.2022 - 04.2025
- Reviewed patients' insurance forms and cards to ensure completeness and accuracy for billing and payments.
- Review patients insurance forms and cards to ensure completeness and accuracy as required by health plans and commercial insurance carriers for billing and payments.
- Pre-register scheduled appointments, receive and record payments for medical treatment.
- Reconcile daily charge sheets of patients' visits to ensure charges for services are billed and captured in a timely manner.
- Conducted registration audits to ensure accurate pricing of claims, enhancing overall billing integrity.
- Reconcile daily charge sheets of patients' visits to ensure charges for services are billed and captured in a timely manner.
Administrative Assistant/Receptionist
Kaiser Permanente
Corona, CA
03.2021 - 08.2024
- Assisted members with self service kiosk for registration and co-payment of medical services, ensuring smooth transaction process.
- Actively seek information to understand members' circumstances, expectations and needs.
- Greeted members and provided reception services, assisting and directing them to appointment locations and admissions efficiently.
- Collaborated with cross-functional teams to support project execution and workflow improvements.
- Assisted in budget tracking and expense reporting for departmental projects.
Pharmacy Assistant
Costco Wholesale
Corona, CA
01.2018 - 04.2020
- Answers phones and provide prompt and courteous customer service.
- Tracks packages, place orders, and refers call to pharmacist.
- Retrieve and sort prescriptions from fax machine and mail, print electronic faxes.
- Enters and updates credit card information, create invoices, submit claim for billing.
- Operated pharmacy software for processing prescriptions and tracking customer profiles efficiently.
- Collaborated with healthcare professionals to provide accurate information regarding medication usage and benefits.
Billing Reimbursement Specialist
Option Care
Corona, CA
05.2017 - 01.2018
- Correctly determines quantities and price for drugs billed. Verifies the service and products are correctly authorized and the required documentation is on file.
- Ensures invoices are submitted for services and products properly ordered and confirmed as provided.
- Ensures all required documentation for billing is completed and accurate prior to claim submission.
Prior Authorization Specialist
Optum rx
Cypress, CA
12.2013 - 05.2017
- Request Medical Records from medical provider, Review Chart notes, lab work, clinical documentation.
- Review Pharmacy benefits and clinical guidelines to determine coverage of medications based on a review of patients formulary and plan criteria.
- Enter online approvals, denials and necessary edits and overrides per guidelines and procedures.
- Enters order for prescriptions confirms shipping and inputs tracking information.
- Verifies pricing is accurate and submits prescription claims.
Education
High school diploma -
Parkridge Private Academy
Remote05-2015
Skills
- Case Management (7 years)
- Medical Billing (10 years)
- Pharmacy Technician Experience (7 years)
- Medical Coding (7 years)
- Hospital Experience (3 years)
- Medical Records (7 years)
- Insurance Verification (10 years)
- ICD-10 (7 years)
- Medical Terminology (10 years)
- ICD-9 (7 years)
- Bilingual (10 years)
- Typing (10 years)
- Administrative experience (10 years)
- Documentation Review
- Auditing
- Medical Scheduling
- Epic
- Data entry proficiency
- Policy interpretation
- Insurance regulations
- HIPAA compliance
- Effective communication
- Strong analytical skills
- Confidentiality
Assessments
- Customer focus & orientation — Proficient
- December 2021
- Responding to customer situations with sensitivity
- Full results: Proficient
- Medical terminology — Proficient
- Understanding and using medical terminology
- Protecting patient privacy — Proficient
- Understanding privacy rules and regulations associated with patient records
- Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
Languages
Spanish
Full Professional
Timeline
Denials/Appeals Coordinator
Kingman Regional Medical Center
04.2025 - Current
Admissions & Collections Clerk
Riverside University Health System
02.2022 - 04.2025
Administrative Assistant/Receptionist
Kaiser Permanente
03.2021 - 08.2024
Pharmacy Assistant
Costco Wholesale
01.2018 - 04.2020
Billing Reimbursement Specialist
Option Care
05.2017 - 01.2018
Prior Authorization Specialist
Optum rx
12.2013 - 05.2017
High school diploma -
Parkridge Private Academy