Senior Revenue Cycle, Authorization, Healthcare Call Center, & Patient Access Specialist with 20+ years of experience in high-volume outpatient, surgical, and healthcare call center environments. Expertise in prior authorizations, insurance verification, denial resolution, accounts receivable management, and payer communications. Proven ability to manage complex patient accounts, resolve insurance issues efficiently, and support revenue cycle operations in both remote and in-office settings. Strong background in customer service, inbound/outbound call handling, and multi-tasking within fast-paced healthcare environments. Bilingual in English and Spanish with exceptional patient communication and problem-solving skills.
Overview
30
30
years of professional experience
Work History
Patient Account Representative II
Guidehouse
11.2023 - 11.2025
Worked in a high-volume healthcare call center environment supporting hospital and outpatient revenue cycle operations
Managed inbound and outbound calls with insurance carriers, patients, and payer representatives regarding claims, billing discrepancies, account balances, and reimbursement issues
Performed detailed accounts receivable follow-up to resolve denied, rejected, underpaid, and aging claims
Verified insurance benefits, claim status, eligibility, and authorization requirements with commercial and government payers
Researched billing issues and implemented corrective actions to reduce reimbursement delays and prevent revenue loss
Maintained productivity, quality assurance, HIPAA compliance, and call handling metrics in a fast-paced remote setting
Accurately documented all account activity, payer communication, and resolution outcomes within billing systems and payer portals.
Business Office Lead / Surgery Scheduler / Insurance Verifier
Beach District Surgery Center
Redondo Beach
09.2015 - 04.2023
Led front-end revenue cycle operations, including scheduling, authorizations, and insurance verification
Obtained prior authorizations for surgical procedures, ensuring medical necessity and compliance
Reduced authorization delays by reviewing clinical documentation and improving coding accuracy
Coordinated surgical schedules with physicians, patients, and facilities
Managed patient financial counseling, including cost estimates and collections
Supported the billing team with claim follow-up and denial resolution
Verified insurance coverage, obtained prior authorizations, and processed claims for PPO and HMO patients.
Maintained low accounts receivable, submitted appeals, and corrected claim denials.
Posted insurance and patient payments accurately.
Educated patients on financial responsibilities and out-of-pocket costs.
Business Office Lead / Insurance Verifier
Kerlan-Jobe Orthopedic Clinic
Los Angeles
07.2006 - 09.2014
Oversaw billing, collections, and A/R reconciliation for multiple physicians and imaging services.
Conducted insurance verification, pre-certification, and financial counseling.
Supervised front desk workflow and staff to reduce billing errors.
Managed bank reconciliation, invoicing, and charge entry.
Trained staff and optimized workflow for office efficiency.
Billing Clerk
US Diagnostics
01.1998 - 01.2001
Processed claims, verified insurance, and performed data entry.
Office Clerk
OBGYN Office
01.1996 - 01.1998
Patient registration, scheduling, and insurance verification.
Casino Host
Harrah’s Casino
01.2001 - 01.2006
Customer service, reservations, and telemarketing.
Education
Harbor Junior College
CMI High School
UMSNH University of Accounting and Administration
Cambria English Institute
Skills
Medical Billing
Collections
Charge entry
CPT coding
ICD coding
Claim submission
Denial resolution
Accounts receivable management
Patient financial counseling
Insurance follow-up
Out-of-network pricing
Appeals
Insurance Verification
Pre-Authorization
PPO
HMO
Medicare
Medicaid
Workers’ comp
Personal injury
Motor vehicle
Student insurance
Self-pay/uninsured
Third-party payer
Tricare
Veterans insurance
Lien negotiations
Pre-certification
Eligibility verification
Office Administration
Technical Skills
Scheduling
Patient registration
Front desk supervision
Workflow optimization
Bank reconciliation
Zoom
Teams
Google Office
Grammarly
EMR
EHR
Misys Tiger
IDX
GE IDX
Centricity RIS-IC
Cerner
Medtek
HST
COUPA
Moneris
Smart System
ZirMed Z-Pay
Powerscribe
Synapse
Viztek
E-pay
Epic
GE Centricity
Misys
AS-400
Microsoft Office
Billing platforms
Payer portals
Patient counseling
Effective communication
HIPAA compliance
Organizational skills
Multitasking
Problem-solving
Self-starter
Team leadership
Staff training
References
Available upon request
Additional Professional Experience
Throughout periods of career transition, family obligations, and independent contract work, continued providing administrative support, supervised visitation services, and healthcare-related customer service while maintaining current knowledge of insurance verification, patient access, and revenue cycle processes.