Rudy Quezada
Visalia
Summary
Knowledgeable Education Program Leader offering proven team building and program oversight abilities developed over 7-year progressive career in education. Practiced at coordinating facility space, resources and staff to efficiently meet dynamic demands. Well-organized, proactive and tactful in working with individuals of all backgrounds. Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Health Insurance and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.
Overview
11
11
years of professional experience
Work History
Lead Patient Care Coordinator
Adventist Health Hanford
11.2023 - Current
- Enhanced patient care by implementing efficient scheduling and coordination processes.
- Streamlined communication between healthcare providers, resulting in improved patient outcomes.
- Decreased patient wait times through effective resource allocation and appointment management.
- Boosted patient satisfaction by addressing concerns promptly and resolving issues in a timely manner.
- Trained new Patient Care Coordinators to ensure consistent quality of service across the team.
- Collaborated with multidisciplinary teams to develop comprehensive care plans for patients with complex needs.
- Reduced administrative errors by implementing standardized documentation procedures for patient records.
Patient Access Representative
Adventist Health Hanford
11.2022 - 11.2023
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record and insurance information.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Provider, Specialist outreach to obtain Insurance Information, Records for Surgery, Radiology, Labs and X-Rays
- Acted as main point of contact for patients, doctors, and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Trained new staff on hospital processes and procedures.
- Educated patients on importance of preventive health care and insurance coverage.
Education Program Leader
ProYouth Expanding Learning
06.2013 - 10.2022
- Stayed abreast of local, state and federal regulations impacting corporate compliance.
- Leveraged job-specific knowledge and abilities to identify solutions to issues and diminish conflicts.
- Trained, managed and motivated employees to promote professional skill development.
- Established and enforced modern educational standards to support student needs.
- Worked with parents and staff to improve student behavioral and learning issues with proactive approaches.
- Maintained current knowledge of applicable codes and required procedures to optimize learning environments.
Lead Medical Claims Processor / Technical Coach
Cigna
06.2014 - 01.2021
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Accurately processed large volume of medical claims every shift.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Inputted data into systems, maintaining accuracy of provider coding information and reported services.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Sent clinical request and missing information letters to obtain incomplete information.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Assisted new policyholders with processing claims.
- Managed customer expectations by clarifying needs, identifying options and recommending products and services.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Modified, updated and processed existing policies.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Reduced claim processing time for faster customer service and improved satisfaction rates.
- Enhanced claim processing efficiency by implementing new software and streamlining procedures.
Education
Certificate - Medical Billing & Coding
Visalia Adult School
Visalia06.2022
Bachelor of Arts - Health Care Administration
University Of Arizona Global Campus
Arizona05.2022
Associate of Science - Business Administration Management
San Joaquin Valley College
Visalia, CA09.2011
Skills
- Training & Development
- Medical Terminology, HCPCS, ICD-10
- Payment and Investigation Escalations
- Medical Claims Processing
- Provider Relations
- HIPAA Compliance
- Electronic Health Records Systems
- Multi-Line Telephone Systems
- CERNER Patient Registration Processing & Admissions
- Health Insurance Verification
- Performance Evaluation
Languages
Spanish
Full Professional
Timeline
Lead Patient Care Coordinator
Adventist Health Hanford
11.2023 - Current
Patient Access Representative
Adventist Health Hanford
11.2022 - 11.2023
Lead Medical Claims Processor / Technical Coach
Cigna
06.2014 - 01.2021
Education Program Leader
ProYouth Expanding Learning
06.2013 - 10.2022
Certificate - Medical Billing & Coding
Visalia Adult School
Bachelor of Arts - Health Care Administration
University Of Arizona Global Campus
Associate of Science - Business Administration Management
San Joaquin Valley College
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