Navia Duarte Turlock, CA *****

209-***-****

ad499s@r.postjobfree.com

Professional Summary

Excellent with medical terminology, IDX, ICD-9, ICD-10, CPT HCPCS, 10 Key by touch, MS Windows, MS Office, EPIC, and Excel. Communication with various insurance providers regarding eligibility, authorization and billing, HMO, PPO, POS, Medi-Cal, and Medicare. I’m able to work with others well in a team setting, independent, multi-tasking and under pressure. I bring with me outstanding analyltical, communication, presentation and organization skills, I’m a quick learner and resourceful problem solver.

EXPERIENCE

Sutter Care At Home, Sutter VNA & Hospice

(Authorization Specialist III)

Sacramento, CA

11/2016 to 07/2017

● Coordination of high volume of speciality prescription therapy referrals

● In-depth analysis of clinical information to ensure it is complete, accurate, and within Sutter Health guidelines, and within Medi-cal, Medicare guidelines if applicable

● Review of all insurance Contracts to determine insurance benefits and copays, obtains authorization for services

● Contact patient regarding guidelines and path to payment for services to be rendered and goes over benefits and paperwork needed for billing, AOB/HIPPS forms.

● Once the process is completed, send email to the appropriate dept. for dispense.

● Establishment and management of positive working relationships with physicians and staff, as well as other medical professionals, patients and colleagues as necessary to accomplish company goals.

● Ensure client confidentiality by adhering to strict privacy policies when handling sensitive information during intake process Crescent Healthcare, Hayward, Ca — Re-Authorization Specialist

9/2007 - 11/2012

Verification of insurance (type/level of coverage for eligibility with SKILLS

● Eligibility Review

● Intake Assessment

● Data Entry

● Case Management

● Computer Proficiency

● Medical Terminology

● Attention to detail

● Conflict Resolution

● Insurance Knowledge

● Multi-line Phone

system

● Patient scheduling

● Microsoft Access

● Discharge Planning

● Authorization

Requirements

LANGUAGES

English

CCS,GHPP, and private insurance accounts payable(resolve reimbursement issues with accounts, billing, sales force & management), track new/ongoing md orders, update system, initiates admissions process for patient referrals, and monitor reports to avoid delays in customer billing. Obtain authorization, Sars and Tars for home infusion, Enteral and skilled nursing visits.

National Pool Tile and Stone, Livermore — Sales Clerk 5/2003-11/2006

Greet and assist customers upon entering the store. Answer phones and report all stock/supply shortages. Ensure the store is always clean; straighten and dust, shelves keep displays and counter areas clean.

Other Duties as needed such as sending our samples of tiles to Pool companies or prospective customers.

EDUCATION

Arnold Beauty College-Fremont Ca

4/2011-9/2012

Robertson High, Fremont Ca — Diploma

6/2000

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