Vera Nye Mendoza

• Delivers specific delegated Eligibility tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. May handle National Accounts or more complex accounts. Reconciles accounts for non-standard requests. May provide technical support for the electronic processing of eligibility. Ensure customer data is installed accurately and on time. Analyzes formats that are customized directly by the client. May work directly with Systems to design formats. Provides recommendations to decrease errors. Thorough technical knowledge of manual and automated eligibility. Completes day-to-day Eligibility tasks without immediate supervision but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members

Contacted insurance payers and followed up with clients and patients on financial obligations, verifying coverage benefits and eligibility to estimate out-of-pocket costs for genetic testing and complete pre-certification and authorization.

Addressed patient billing inquiries, clarifying copayment obligations and authorization processes to enhance patient understanding.

Utilized expertise in DME HCPC codes and diagnosis codes for accurate data entry and processing.