GLORIA L. SILVA NIEVES
Vega Baja
Summary
Dynamic professional with extensive experience in high-level organizational support and team guidance to achieve strategic objectives. Proven expertise in conducting audits, managing confidential documents, and ensuring compliance with state and federal regulations while fostering effective communication with internal and external stakeholders. Recognized for exceptional interpersonal skills and a strong ability to thrive in independent and collaborative environments. Committed to driving results and enhancing operational efficiency through innovative problem-solving and proactive leadership initiatives.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Customer Service /Office Data Entry Clerk
Palm Medical
Coral Gables, Florida
01.2019 - 12.2022
- Make calls to patients to coordinate appointments, referrals, authorizations, etc. Resolve patient concerns while maintaining a high level of customer satisfaction.
- Enter information about the patient with precision and confidentiality by carrying out the federal laws and regulatory rules on HIPAA.
- Receiving and/or making about 60 calls and fulfilling about 40-50 according to need and availability.
- Keep the information regarding the patient's medical record updated. Collaboration and integration with medical plans.
- Prepare reports to the supervisor on the management of information, highlighting important points of production and improvement.
Office Manager
PFS Investments
Miami, Florida
10.2017 - 01.2019
- Handle life insurance policies during the approval process, complying with state and federal regulatory laws.
- Monitor customer service operations, ensuring the receipt and sending of the information required by the insurance company, working for the fulfillment of making 25 daily policies.
- Prepare financial reports on the number of policies and their financing.
- Manage calendars, appointments and meetings.
Billing and Collections Auditor
CMS Home Care
Bayamon, PR
03.2012 - 09.2017
- Develop compliance strategies and protocols regarding the medical billing process efficiently, implementing that the information is received on time and correct to be submitted diligently and promptly to the main medical plans.
- Perform audits for the recovery of denials, working to comply with 100% and minimize pending accounts; achieving a percentage of seventy.
- Organize and make monthly reports on the process of invoicing and pending recovery of medical plans and/or patient accounts.
Education
BA - Natural Science-Biology
Universidad Central De Bayamon
12-1994
High School Diploma -
Lino Padro Rivera High School
05-1985
Skills
- Effective organizational skills
- Effective team collaboration
- Insurance report preparation
- Effective verbal and written communication in English and Spanish
- Skilled in using Microsoft Office tools
- Self-directed and team-oriented work
- Skilled in multitasking effectively
- Experienced in budget coordination
- Customer support
Certification
- Billing & Collection, ICD-10, Electronic Claims- Medical Billers Association of Puerto Rico (AFAMEP)- Bayamon, PR
- Essential Audit Skills- Horizonte Healthcare and Consulting Group- Bayamon, PR
- ICD- 10 Section- Medical Card System (MCS) ICD-10 Academy- Hatillo, PR
- HIPAA Regulations- ACOSES- San Juan, PR
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
Customer Service /Office Data Entry Clerk
Palm Medical
01.2019 - 12.2022
Office Manager
PFS Investments
10.2017 - 01.2019
Billing and Collections Auditor
CMS Home Care
03.2012 - 09.2017
BA - Natural Science-Biology
Universidad Central De Bayamon
High School Diploma -
Lino Padro Rivera High School