Natalia Zapata

Interacted professionally with providers and staff to provide appropriate and timely responses to inquiries and concerns regarding provider enrollment and maintenance for Medicare, Medicaid, Blue Cross, Blue Shield, CAQH and other payer programs. Responsible for all aspects of payer portal access for individual providers.

Advanced from agent to Team Lead/Mentor within three months, assisting in overseeing a department staff of 25-30 agents. Collaborated with management to monitor daily queue call volume, utilizing inbound performance data reports and Work Force to ensure productivity and efficiency in call responses and handle time, as well as schedule adherence.

Handled an average of 50-75 inquiries daily for patients and physicians, escalating emergency phone calls to physicians or MAs. Managed EMR note updates, patient registering and scheduling, and updated/verified insurance information.

Responded to member inquiries for Individual & Family Plans, Medicaid Plans, and Foster Care Medicaid. Reviewed benefits, authorizations, prescription statuses, and assisted with provider lookup and appointment setup.

Handled member inquiries for Individual & Family Plans for BCBS and Medicare Advantage Plans for Cigna HealthSpring. Reviewed and adjusted claims, reviewed benefit costs, and assisted with provider lookup and appointment setup.

Completed a comprehensive program in Medical Billing & Coding, gaining proficiency in industry-standard practices and regulations. Acquired skills in medical terminology, ICD-10-CM, CPT, and HCPCS coding.