Carolina Esquivel Aleman

acgcbl@r.postjobfree.com

562-***-****

October 2014

Re:Medical Authorization Assistant

Dear hiring Manager

I Carolina E.Aleman, am a highly motivated Medical Authorization/ Collections Representative . I have over 10+ years in professional Authorization/Billing and Collections in the following areas: Pediatrics, Cardiology, General surgery, Neurology, Ortho, Gastro, Pain management knowledgeable. I am very comfortable with working with state programs and health care providers. I also have experience in posting payments, co-pays, Commercial and managed care.Experience in filing Appeals and Reimbursements, EOB’S, SARS, Carve outs, CIF’s, TAR’s. Submit proper medical records for Authorization request and follow up with Insurance and members for Authorization outcome and document account. I have the ability to communicate with people and negotiate with assertiveness, while managing to provide excellent customer service.

I have attached a resume for your review.

I would like to thank you in advance for your time and consideration. I hope to hear from you soon to arrange a time to further discuss my skills and qualifications.

Sincerely,

Carolina Esquivel Aleman

Resume*

Carolina E. Aleman

acgcbl@r.postjobfree.com

562-***-****

Professional Profile

• 10+ years of experience with Clerical and Admin position in Healthcare Industry

• Experience with Claims Processing, Managed Care and Patient Demographics

• Knowledge in Medicare, Medi-Cal, CCS Authorizations request and follow up, and commercial payors

• Proficient in Microsoft Office, Quest, STARS, AS400, GE, IDX, Provider Link, Cerner, Epic and Hype

• Bilingual in English and Spanish

Professional Experience

Aug 2013 – Apr 2014 UC Irvine Orange, CA

Registration Representative

• Performed insurance verification and interaction with insurance companies and patients

• Handled registration of patients with demographic and insurance information

• Created stand-alone visits for Pathology, Psychiatric, Emergency and Nursing facilities

• Handled claim denials and resubmitting claims with correct insurance information

• Reviewed and audited accounts

• Checked invoices with correct insurance information to adjudicate timely billing and account reimbursement

•Obtain medical records to request Authorizations for procedures

• Follow Up with insurance and patient, document account

• Created new and old Workers Compensation cases, authorizations and self-pay GERD

Sept 2012 – Mar 2013 Children’s Hospital of Orange County Orange, CA

Financial/Authorization Coordinator

• Answered high volume of calls to resolve patient inquiries regarding authorization and procedures

• Scheduled appointments for various Subspecialty departments

• Updated and verified patient and insurance information

•Gather medical records to request authorizations for procedures

• Follow Up with Insurance and members, authorization outcome

•Document case information into system, for proper tracking

• Preregistration of patient charts

Mar 2008 – June 2011 Kaiser Permanente Downey, CA

Financial Counselor

• Obtained and review patient demographics

• Performed follow up on financial assistance application

• Identified potential TPL and W/C

• Screened for potential government programs and verified insurance benefits and eligibility

• Coordinated, collected and posted copayment and deductibles

• Ensured that all documentation in the billable jacket is complete

Aug 2007 – Mar 2008 Medical Center for Women Fullerton, CA

Collections

• Printed daily report and checked claims status

•Payment Arrangements

•Final notice letters mailed

• Self pay/Insurance Collection

• Handled cash journals and follow up on payment plans

• Met productivity point of service collections

May 2005 – May 2007 Western Medical Center Anaheim, CA

Admission ER Department

• Obtained patient demographics

• Verified insurance benefits and eligibility

• Entered copayments received at time of service

• Handled MSI application approval process and follow up

• Managed care (HMO, MediCal, Medicare, PPO, etc.)

• Performed Utilization review, social service and case management

• Handled inpatient/outpatient authorizations

Jan 2004 – May 2005 Marina Medical Billing Cerritos, CA

Insurance Follow up Clerk

• Filed appeals and denials

• Follow up on outstanding accounts by financial class

• Documented follow up activity

• Met productivity and quality goals

• Rebilled for timely filing

Sept 2002 – Jan 2004 Centinela Hospital Inglewood, CA

Patient Service Representative

• Obtained patient demographics

• Screened insurance eligibility

• Processed and distributed charts

• Handled collections for deductible and copayments

• Performed other clerical duties

Education

West LA College

Culver City, CA

Certified in Medical Terminology/Billing/Coding

2003

HASC Program Certified MSI 2005

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