Maria R Figueroa
Phoenix
Summary
Dedicated and highly skilled healthcare reimbursement professional with over 8 years of progressive experience in medical billing, field reimbursement, patient access, and payer engagement. Extensive expertise in benefit investigations, prior authorizations, claims submissions, appeals management, and patient support program navigation across commercial, Medicare, and Medicaid plans. Adept at delivering provider education both virtually and in-person, managing complex reimbursement workflows, and collaborating with hubs and manufacturer partners to resolve access barriers. Proven ability to track program performance, support CRM reporting, and ensure compliance in fast-paced, regulated healthcare environments. Passionate about driving timely access to therapies and elevating provider and patient experience across the reimbursement lifecycle.
Overview
10
10
years of professional experience
Work History
Reimbursement Specialist I
Lumerica Health Services
Phoenix
06.2024 - Current
- Deliver detailed reimbursement education to providers related to benefit verification, prior authorization requirements, claims submission, and appeals handling.
- Conduct virtual support sessions addressing medical necessity documentation, coding accuracy, and payer coverage guidelines for Medicare, Medicaid, and commercial plans.
- Assist provider offices and patients with navigating patient support programs, co-pay assistance, and financial hardship pathways.
- Coordinate with internal hubs to monitor service level agreements (SLAs) and expedite access by resolving claim holds, denials, and incomplete authorizations.
- Maintain accurate case activity in CRM systems for territory tracking, performance measurement, and compliance auditing.
Senior Medical Billing Specialist
CVS Health
Phoenix
07.2016 - 12.2023
- Managed full-spectrum reimbursement activities for high-volume pharmacy claims, including insurance verification, appeal drafting, and denial resolution.
- Partnered with internal stakeholders and external payers to investigate coverage issues, submit supporting documentation, and expedite claim payment.
- Provided leadership in Epic revenue cycle management, delivering training on charge review, edits, and billing workflows tailored to payer-specific requirements.
- Authored and implemented claim resolution workflows and denial management protocols, reducing claim cycle time by 25%.
- Interpreted payer guidelines, NDC and HCPCS crosswalks, and plan policies to optimize reimbursement capture and minimize underpayments.
Inbound Patient Services Representative
TriWest Healthcare Alliance
Tempe
08.2015 - 07.2016
- Delivered frontline support on benefit eligibility, referral status, and claims inquiries for veterans enrolled in the Community Care Network (CCN).
- Facilitated prior authorization coordination, appeals routing, and provider-patient communication for care continuity.
- Ensured timely issue escalation and case tracking in CRM systems to meet operational standards and program goals.
Education
High School Diploma -
BUCKEYE UNION HIGH SCHOOL
05-1999
Skills
- Field & Virtual Reimbursement Support
- End-to-End Claims & Appeals Management
- Benefit Investigation & Prior Authorization Navigation
- Medicare, Medicaid & Commercial Insurance Expertise
- Billing, Coding, and Coverage Criteria Interpretation
- Medical Necessity & Documentation Support
- Patient Access & Co-pay Assistance Programs
- CRM Tools, Metrics Tracking & SLA Monitoring
- Hub Collaboration & Provider Education
- HIPAA Compliance & Healthcare Regulations
Languages
Spanish
Native/ Bilingual
Timeline
Reimbursement Specialist I
Lumerica Health Services
06.2024 - Current
Senior Medical Billing Specialist
CVS Health
07.2016 - 12.2023
Inbound Patient Services Representative
TriWest Healthcare Alliance
08.2015 - 07.2016
High School Diploma -
BUCKEYE UNION HIGH SCHOOL
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