Rosalyn T. Santos

***** ******* **** 858-***-**** (Mobile)

San Diego, California 92126 ad0mdd@r.postjobfree.com(E-mail) OBJECTIVE

To obtain a position with a dynamic company that will leverage my technical, organizational and team-oriented skills to benefit company productivity, efficiency, customer service and provide quality patient care. EXPERIENCE

8/21/2023-present Perlman Clinic San Diego, CA

Medical Administrative Assistant

Schedule patient appointments with PCP or various specialities within the clinic.

Experience with using the EPIC system when scheduling patient appointments, sending messages to various providers.

Knowledge of insurances (PPO’s and HMO’s) and providing insurance verification before scheduling patient appointments.

Experience with working in a fast paced-environment while answering calls with a multi-phone line system.

8/30/2020-6/27/2023 Rady Children’s Hospital San Diego, CA Healthcare Authorizations Specialist II

Responsible for ensuring the insurance benefits are verified.

Responsible for ensuring that patient estimates are calculated and communicated to the patient and/or family member.

Obtaining authorizations for the various specialties (nutrition, infectious disease, pain management and behavioral health).

Experience with using the EPIC system in obtaining authorizations and verifying insurance information for patients.

Experience with organization of authorization tasks for various specialities. 08/21/2017- 8/05/2020 Scripps Clinic AOP La Jolla, CA Patient Service Representative

Responsible for greeting new or existing patients and providers in person or by phone to collect necessary information for accurate registration including assigning a Medical Record Number and verifying insurance benefits, copays, etc. before scheduling consultation appointments.

Identifying that a referral is received and authorized before scheduling appointments with our Neurology providers.

Providing proper documentation when taking inbound calls and routing of messages following the department protocols for each provider.

Scheduling and confirming appointments following department protocols for each provider in the neurology department.

Performing Key User duties to override certain tasks to schedule appointments that are approved by the provider.

Submitting referrals for consultations, imaging, specialty medications and/or infusions, DME

(durable medical equipment), physical/occupational/speech therapy and electromyography nerve conduction velocity testing and scheduling appointments when referrals are authorized.

Providing excellent customer service while taking calls or in person and taking ownership and assisting the patient’s needs and accurately identifying the problem and providing solutions with minimal management involvement.

Knowledge of benefits for various insurances Scripps Health Clinic accepts for example, Medicare, HMO, PPO and commercial plans.

01/2017-07/2017 Arch Health Partners San Diego, CA Physician Concierge Scheduling Specialist

Provides excellent customer service to patients and providers and ensuring the service is complete from beginning to end.

Process inbound and outbound authorizations for Family Practice, Rheumatology and Orthopedic Surgery providers.

Scheduling appointments for patients and/or referring physician offices.

Maintaining procedure requests for upcoming surgeries, which includes calculating, estimated patient cost for professional fees and collecting the money due before their scheduled procedure.

Communicating with worker’s compensation insurances and/or adjusters in completing authorizations for patients who require DME, MRI/CT scans, physical and occupational therapy and referrals for other providers.

Knowledge of identifying patient payer sources, verifies insurance eligibility and benefits and determines co-pays and deductibles, PCP changes needed and communicates to patients and front desk prior to appointment.

Knowledge of Medicare, Medicaid, HMO, PPO Out of Network and carve out commercial insurances.

Knowledge of medical terminology and certain diagnoses and their ICD-9/ICD-10 and CPT/HCPC codes and modifiers.

06/2006 – 01/2017 Optumrx Cypress, CA

Prior Authorization Technician

Knowledge of certain diagnoses and their ICD-9/ICD-10 codes while processing drug authorizations.

Knowledge of health care billing inquiries relating to Medicare Part B and D.

Respond to many types and sources of communications as a primary contact to assist physicians, and their agents with prior authorization matters.

Assist members as a secondary reference source for prescription fulfillment through our mail service pharmacy.

Provide reliable information about Optumrx products and services pertaining to the drug authorization and fulfillment process, by accessing various tools and resources.

Make outbound telephone call inquires and/or faxes to both patients and doctor’s offices.

Escalate calls to pharmacists as appropriate.

Receive incoming calls from providers, members and pharmacies assisting with benefits inquiries, prior authorizations and claims.

7/2005 – 10/2005 MedImpact San Diego, CA

Prior Authorization Technician Representative

Assisted members regarding pharmacy benefits.

Review health plan guidelines with physicians to pre-authorize oral medications.

Assisting pharmacy with billing claims correctly while, providing excellent customer service.

Counsel patients regarding non-discretionary information, benefits, use of plan, status of orders, and complex claim or inquiry question.

4/2005 - 6/2005 Aurora Behavioral Health Care San Diego, CA Pharmacy Technician Intern

Facilitated pharmacy billing by inputting medication dose and quantity to update patient account information.

Distributed medications to each ward with the use of cassettes.

Responsible for distributing controlled substances efficiently and accurately.

Participate in monthly ward inspections.

Responsible for all medication inventories.

03/2001 - 03/2005 Phil-Am Auto Repair San Diego, CA Receptionist

Greeted customers in person and over phone.

Answered all phone calls regarding the business.

Managed customer repair appointments.

Explained details of repairs to customers.

Managed inventory of tools and parts.

EDUCATION

Pharmacy Technician I01/2005 - 06/2005

Grossmont Health Occupations Center, Santee, CA

Health Care Essentials 08/2004 - 12/2004

Grossmont Health Occupations Center, Santee, CA

General Education Credits 08/1996 - 12/2001

Miramar Community College, San Diego, CA

High School Diploma 09/1994 - 06/1996

Scripps Ranch High School, San Diego, CA

CERTIFICATION / LICENSES

Health Occupation Certificate

Pharmacy Technician I Certificate

Pharmacy Technician License Number 63210

Certificate of Proficiency in Typing/Keyboarding

REFERENCES

Available upon request

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