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Click here or scroll down to respond to this candidateCandidate's Name
Wesley Chapel, FL Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLESummary of Qualications Fluent bilingual self starter with excellent customer service. Highly organized and attentive to detail with analytical skills. Extremely productive in a high stress environment. Strong oral, written and interpersonal communication skills, problem-solving skills. Employment HistoryElevance Health/AnthemTampa, FlUtilization Management ReviewApril 2022- Present Responsible for coordinating cases for pre certication and prior authorization review Manage incoming calls and incoming post services claims work Authorize non clinical review authorization requests Determine contract and benet eligibility; provide authorization for inpatient admission, outpatient pre certication, prior authorization and post service request. Refer cases requiring clinical review to a Nurse Reviewer. Responsible for the identication and data entry of referral requests into the UM system in accordance with the plan certicate. Respond to telephone and written inquiries from clients, provider and in house departments. Conduct clinical screening process. Authorize initial set of sessions to provider. Check and ensure customer requests and questions are handled appropriately and in a timely manner Route incoming faxes to multiple queues to be processed Knowledge of Medicare and Medicaid Line of Business Tampa Ear Nose and Throat /Florida Pediatric Associates Tampa/Wesley ChapelPatient Surgical Coordinator/Front and Back Desk/Triage May 2012- April 2022 Schedule patients pre operative and post operative appointments. Obtain pre certication and authorization using Availaty, and various insurance provider portals. Collect deductibles and coinsurance prior to scheduled procedures. Educate patients about pre and post operative process. Work directly with physician to ensure accurate interpretation for coding. Obtain proper surgical clearance from multiple physicians for anesthesiologist to approve surgeries. Facilitate communication between physician, hospitals, ambulatory surgery centers, Triage phone calls and patient inquiries in a professional and ecient manner. Scan and attach all documentation using EMR (electronic Medial Record) system. Collect and process patient payments. Register new and established patients Train all new employees. Obtain reports from other hospital provider portals such as Tampa General Hospital, Baycare, Advent Health Florida Hospital, Labcorp, Tower Diagnostics etc. Communicate using e-mail to resolve and handle daily work requirements. Assist with covering front oce responsibilities when short staed. Meet with marketing representatives to streamline Triage patientsShriners Hospital For ChildrenInsurance Specialist/Interpreter/Financial Counselor Tampa, Florida2005-2011 Oversee and coordinate the scheduling of patients being sent o campus for outpatient MRI, CT Scans, Neurology Consults, Pulmonology, EMG/Nerve conducting Studies, Ultrasounds, Ophthalmology consults prescribed Physician Sta. Call insurance companies to obtain medical eligibility and benets information. Obtain pre-certication and authorizations for scheduled visits. Prepare appeal letters for medical denials. Assist medical sta with translating to Spanish speaking patients. Manage monthly, quarterly and yearly savings for outpatient department. Liaison between care coordination, physicians, in-patient department, radiology department. Assist in completing application for low income patient to obtain medical insurance. Back On Track Physical TherapyOce ManagerCoral Springs, FL2003-2005 Managed business oce daily, quarterly and yearly budgets. Interviewed, hired, trained, motivated and disciplined personnel with respect and professionalism. Utilize the Medicare (Direct Data Entry) system to bill, edit, review, obtain payment or denial status. Post payments to all patient accounts and prepared bank deposits. Manage sta schedules ad execute administrative of oce functions. Manage sta schedules and execute administrative oce protocols. Scheduled and prepared marketing visits with clients to discuss competitive billing rates. Advanced knowledge of all major insurance companies such as HMO, PPO, POS, Workers Compensation, Commercial billing software programs. Education:High School Graduate-Medicare Education Certications-Management Required Seminars- HIPPA CerticationSkills/Programs:Microsoft Outlook, CPT coding, ICD-9 and 10 coding, Excel, Availaty, EMR, Power Points, Speak Spanish, Translate, read and write, communicate using E-mail and internal programs. Triage physician and customer phone calls. |
