Mariela Flores
Berwyn
Summary
Dynamic Transplant Financial Coordinator at Loyola University Medical Center with expertise in revenue recognition and patient advocacy. Proven ability to streamline financial processes and enhance operational efficiency. Bilingual communicator skilled in benefits explanation and medical billing, ensuring optimal reimbursement and patient satisfaction. Committed to delivering exceptional service in high-pressure environments.
Overview
19
19
years of professional experience
Work History
Transplant Financial Coordinator
Loyola University Medical Center
04.2016 - Current
- Assisted in preparing financial reports and reconciliations to ensure accuracy and compliance.
- Supported budget preparation processes by gathering and organizing necessary financial data.
- Maintained accurate records of transactions using accounting software for efficient tracking.
- Collaborated with team members to streamline administrative tasks, enhancing overall workflow efficiency.
- Responded to inquiries related to invoices and payments, providing timely resolutions to issues.
- Participated in audits by compiling documentation and ensuring adherence to financial policies.
- Explained insurance benefits, fees and procedures to patients.
- Contacted insurance carriers to discuss policies and individual patient benefits.
- Answered questions over phone and in-person regarding billing, scheduling and treatment.
- Obtaining detailed patient insurance benefit information for all aspects of the transplant process, including, but not limited to, outpatient prescription drugs, organ acquisition.
- Maintain and increase knowledge of Governmental insurance industry coverage and requirements through constant policy changes in relation to organ transplantation.
- Seek maximum reimbursement by contacting Provider Contracting to initiate a letter of agreement process.
- Advise transplant coordinators, transplant surgeons, administration, Patient Financial Service, Managed Care and others as appropriate regarding coverage and billing issues affecting transplant.
- In contact with the PCP, Dialysis Center, Nephrology and anyone else to expedite the information the insurance company needs in order to approve the transplant workup and Listing for UNOS.
- Provides financial counseling and education to transplant patients and families regarding their specific insurance coverage, deductible, copayment, and required deposits.
- Maintains communication with transplant patients on the waiting list in order to verify and document ongoing insurance coverage and any benefit changes during the waiting period.
- Serve as a patient liaison/advocate to assure patients ease in all transplant related insurance matters during the patient relationship with the Transplant Program.
- Attend Clinic, MRB and Education programs to provide insightful input on the financial impact of patients care.
- Credit Report (refund patient/insurance), Charge Corrections, Keep track of missing charges.
- Assist front-desk/providers with resolving patient invoices
- Identify/Correct Registration Edits
- Manage Patient/Payment Estimator
- Utilization Review
- Secure Upfront Payments
- Financial Assistance Support
- Initiate/Offer financial loan program
- Secure Collections on Self Pay/Insured Patients for Surgeries Out-Patient/In-Patient.
- Meet with patients in office
- Preauthorizing In Patient and Out Patient Surgeries, procedures, injections, and radiology services.
- Reviews patient registrations, obtains benefit verification and necessary authorizations (referrals, precertification) with procedures, Infusions, pain management injections, and radiology services. GI Lab (EGD & Colonoscopy) Echocardiographic Procedures, Sleep Studies.
- Utilizing Epic, eCare NDAS, eCare Passport
- Creating hospital account records to insure accurate billing to increase cash flow and revenue collection for the Health System.
- Creates HARs for appointments after obtaining benefit information and authorizations. Centralizing registration process insurance denials, increase revenue, and patient satisfaction.
- Perform insurance verification/precertification for all scheduled ambulatory visits including, but not limited to, office visits, radiology visits, high cost drug infusions.
Case Review Coordinator/Pharmacy Technician
CVS Caremark Specialty Pharmacy
11.2011 - 03.2016
- Coordinator for Case Review Unit for Specialty Guidelines Management Programs
- Patient data entry, managing and reporting
- Reviewing Client and Drug Criteria & Re-authorization referrals
- Assigned to Health Plans (Non NY Managed Medicaid, Tuft’s, Lowes, Care First)
- Assigned SGM 2 and SGM 1 (Infertility, Growth hormone, Anemia) cases
- PA review criteria questions for approvals or denials; follow up calls, and communicate referral dispositions.
- Processing Billing Claims for Denials and Approvals.
- Coordinated medication review processes to ensure compliance with regulatory requirements.
- Led cross-functional teams to streamline workflow and enhance operational efficiency in specialty pharmacy services.
- Facilitated communication between healthcare providers, patients, and internal teams to resolve issues promptly.
- Mentored other coordinators on best practices in medication management and patient engagement strategies.
Office Manager
Centro Medico Del Pueblo Chicago
02.2009 - 07.2010
- Oversaw daily office operations, ensuring efficiency and organization across all departments.
- Developed and implemented office policies to enhance workflow and productivity.
- Managed scheduling for team meetings, coordinating resources and materials effectively.
- Trained and mentored new staff on administrative procedures and office systems.
- Verified Insurance for approval of treatment with BCBS: PPO, HMO, Worker's Compensation and personal injuries
- Workman’s compensation - Podiatry/Orthopedic/Neurosurgeon/General surgeon/Pain Management/Family doctor
- Completed insurance verification both over the phone and through online systems for inpatient and outpatient procedures.
- Authorized over 25 procedures on a daily basis.
- Supported multiple orthopedic surgeons
- Answered telephones, and directed calls to appropriate staff
- Scheduled and confirm patient appointments, surgeries and medical consultations.
- Greeted visitors, ascertained purpose of visit and directed them to appropriate staff.
- Operated office equipment such voice mail messaging systems, and spreadsheet, and other software applications to prepare reports, letter, case histories and medical records.
Office Manager/MA
Los Quiropracticos
01.2007 - 01.2009
- Streamlined office operations, enhancing workflow efficiency and communication across departments.
- Coordinated scheduling for staff and patient appointments, improving overall service delivery.
- Implemented inventory management systems to optimize supply ordering and reduce waste.
- Supervised administrative staff, fostering professional development and promoting teamwork.
- Verified insurance for basic outpatient procedures.
- Supported multiple chiropractors as well as physical therapists
- Interviewed patients to complete documents, case histories, and forms such as intake and insurance forms.
- Compiled and recorded medical charts, reports, and correspondence, personal computer
- Transmitted correspondence and medical records by mail, email, or fax
- Maintained medical records, technical library and correspondence files
- Medical billing and coding.
- Customer service
- Receptionist
- Coordinator surgical and clinical dates
- Communicate with staffing agencies our surgical needed/requirements
- Communicate with surgeons/anesthesia/ sales reps/internal staff/patients, surgical dates/time
- Confirm and provide the patients with the pre procedure instructions
- Coordinate transportation services provided for the patients, a day in advance
- Check patients in and out
- Take patient vitals and log within EMR
- Translate for patients
- Coordinating specimen pick up through Quest Diagnostics, on an as needed basis
- Order medical supplies for the laboratory, exam rooms, surgical equipment and medication - On monthly basis
- Stock and clean exam rooms after each clinical day
- Dispense sealed medications to patients
- Release medical records, after proper protocol
- Entering daily services
- Assist in the Physical Therapy Department (under the supervision of an MD)
- (e.g putting modalities on patients lower back, making sure they are doing their exercises correctly, showing them exercises that can be done at home)
Education
Associate of Arts -
Morton College
Cicero, ILHigh School Diploma -
Farragut Career Academy
Chicago, ILPhlebotomy -
National Latino Education Institute
Chicago, ILSkills
- Verbal and written communication Bilingual- Fluent in both English and Spanish
- Revenue recognition
- Microsoft Excel
- Data entry
- Benefits explanation
- Accounts payable
- Invoice processing
- Appointment scheduling
- Payment collection
- Telephone etiquette
- Proficient in EPIC, OneSource/E-Care Clinical Authorization System CAS, People Safe, CATS, Medisoft, Microsoft Office, Excel, -Power Point, Word, I-Centric, Nasco, Facets EZBIZ, Advantx, Medsource, EHR, Eaglesoft, Greenway, Availity
- Secure Collections on Self Pay/Insured Patients for Surgeries Out-Patient/In-Patient
- Credit Report (refund patient/insurance), Charge Corrections, Keep track of missing charges
- Office management skills and EMG and NCV Transmitting data
- Medical billing and coding
- Pharmacy Technician
- Call Center Financial Clearance Center
- Phlebotomy
Languages
English
Full Professional
Spanish
Native or Bilingual
Timeline
Transplant Financial Coordinator
Loyola University Medical Center
04.2016 - Current
Case Review Coordinator/Pharmacy Technician
CVS Caremark Specialty Pharmacy
11.2011 - 03.2016
Office Manager
Centro Medico Del Pueblo Chicago
02.2009 - 07.2010
Office Manager/MA
Los Quiropracticos
01.2007 - 01.2009
Associate of Arts -
Morton College
High School Diploma -
Farragut Career Academy
Phlebotomy -
National Latino Education Institute
Similar Profiles
Michelle D. PanockMichelle D. Panock
Nurse Manager 3 SE Cardiology-37 Bed Cardiac Unit at Loyola University Medical Center/Loyola MedicineNurse Manager 3 SE Cardiology-37 Bed Cardiac Unit at Loyola University Medical Center/Loyola Medicine
Tyra WebbTyra Webb
Registered Nurse at Loyola University Medical CenterRegistered Nurse at Loyola University Medical Center
Shamarey CobbinsShamarey Cobbins
Dietary Assistant at Loyola University Medical Center-Trinity Health SystemsDietary Assistant at Loyola University Medical Center-Trinity Health Systems
Courtney WhiteCourtney White
CNA at Loyola University Medical CenterCNA at Loyola University Medical Center
Cora PechousCora Pechous
Supervisor at Ditka's RestaurantSupervisor at Ditka's Restaurant