Prior Authorizations Worker's Compensation
Resume:
Alba Rodriguez
Las Vegas, NV *****
*********@**.***
To acquire a position with a well-established company or firm, progress upwardly within that establishment, and obtain new and relevant workforce skills while potentially building a long term career/relationship.
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Prior Auth/ Referral Coordinator
Neurology Center of Nevada - Henderson, NV
March 2021 to Present
• Obtain prior authorizations for EMG/NCS, EEG Routines, EEG Sleep Deprived and Prolong. All Sleep studies and CPAP Titration.
• Fax Outgoing Referrals and submit authorizations if needed depending on patient insurances.
• Submit prior authorizations for Botox injections
• Submit prior authorizations for all diagnostic imaging that are being requested by providers
• Assist providers in translating patients (Spanish) when needed. New Patient Coordinator
Nevada Spine Clinic - Las Vegas, NV
September 2018 to November 2020
• Handle all incoming referrals in a timely manner and coordinate referrals and ensuring that all needed data and information is obtained at the time of referral intake or follow-up.
• Verify all medical insurances, Worker's Compensation and attorney liens.
• Communicate with the patients and explaining their medical benefits prior to scheduling.
• Obtain authorization for all new and ongoing services as needed.
• Continually track all services requiring authorization.
• Document all conversations and coordinate with staff all services authorized by payor.
• Handle high volume of incoming calls (40-60 calls per day) through inbound ACD for appointment requests, directions and multiple inquiries.
• Collect and/or confirm patient demographics and insurance information as required and accurately enter data into department's scheduling system.
• Monitor physician and clinical schedules daily.
Authorization Coordinator/Surgery Authorization Coordinator Nevada Spine Clinic - Las Vegas, NV
September 2018 to November 2020
• Handle all Prior Authorizations for musculoskeletal injections, DME’s and Spinal Surgeries being performed at the Ambulatory Surgical Center, Radiology and our inpatient/outpatient Hospitals.
• Submit all Prior authorizations to all insurances including State Insurances, Commercial, Worker’s Compensation, Attorney Liens and third parties.
• Coordinate several physicians’ and patients’ schedules with outside testing facilities, radiology offices' and surgery center.
• High volume verify insurance eligibility & obtain authorizations that will be performed at the Smoke Ranch Ambulatory Surgical Center, MRI center at Nevada Spine Clinic, Allegiant Spine Institute at Nevada Spine Clinic.
• Knowledge of Insurance coding (CPT and ICD-10).
• Contact patients and facilities in a timely fashion, and organize maintaining accurate, up-to-date lists.
• Send order, demographics, and Id/insurance cards to the facilities so they are aware of the upcoming cases.
• Initiate and submit surgery authorization. Most times a follow up call is needed to check status or approval.
• Request and follow up on medical records Mas did not obtain prior to consultation as well as any additional medical
• Records (pre-op test results) needed for surgery.
• Send the medical/cardiac clearance request along with request for pre-op/cardiac test results to cardiologist or PCP as well as following up to request records before surgery.
• Process and fax surgery packet to facility.
• Explain to patient their surgery benefits and collect payment on any surgeon expense as mandated by their insurance.
Front Desk Receptionist
PERFORMANCE PHYSICAL THERAPY - Las Vegas, NV
October 2016 to April 2018
•Greet patients and visitors in a friendly manner.
• Verify patient demographic and insurance information at the time of check-in and correctly enter into the EMR/ASPC/system.
• Take intakes and Verify patient information by confirming insurance eligibility and benefits.
• Confer with patients when their has been changes to their insurance information.
• Discuss insurance and payment questions with patients.
• Verify eligibility and benefits for scheduled patients.
• Properly identify amounts owed by patient at the time services are rendered.
• Collect all patient payments owed at the time of the visit.
• Obtain patient updated insurance card and picture ID.
• Ensure patients receive proper forms to be completed based on their appointment.
• Assist patients with all questions and concerns as they are presented.
• Monitor flow of patients to maintain timely schedule and rooming of patients.
• Scans and uploads all written verification of eligibility and benefits to patient chart.
• Answer incoming telephone calls and route to appropriate department.
• Responds to all messages regarding patient care.
• Schedule patients for appointments.
• Document all patient encounters in EMR/ASPC system.
• Maintain cleanliness of front desk, waiting room, restrooms and kitchen throughout day.
•Follow all HIPAA guides and regulations.
• Submit Prior-Auth and Pre-Certification to medical insurances depending the services and treatments that patient is receiving.
•Medical Records/ Knowledge of HIPAA regulations.
Front Desk Clerk
Bridge Counseling Associates - Las Vegas, NV
July 2015 to October 2016
•Promptly answers incoming calls, screening and routing appropriately. •Take detailed, accurate, legible messages and accurately documenting distributing and/ or tasking messages accordingly.
•Responsible for maintaining knowledge of computer scheduling functions, using proper registration protocols with all new clients, editing existing client’s data, and utilizing proper visit types.
•Maintaining knowledge of all providers’ schedules and restrictions.
•Data Entry registration the demographic and insurance information onto our computer system (Medisoft program).
•Greet clients and visitors to the facility and obtain all required information to register clients. Ensure/ assist clients in completing all forms and route the forms to the appropriate personnel or department.
•Confirm appointments, cancels appointments, reschedules appointments and notify clinical staff of appointment changes per Standard work procedures.
•Discuss scheduling conflicts or problems with supervisors or clinical staff.
•Provide schedule updates during the day.
•Inform clinical personnel when client has arrived.
•Responsible for collecting payments from clients, post payment, maintaining money drawer, balancing monies and turning in completed batch.
•Per office procedures, determines total charges for visit and calculate client financial responsibility per established policies and procedures for cash clients. Collects required co-payments, payments (cash, check, credit card), issues receipts and make change, etc., per standard of work.
•Ensure that billing information and collections are routed to appropriate personnel/ department. May collect past due balance when appropriate.
•Responsible for informing clients regarding Bridge Counseling Associates protocols and confirming patient appointments as needed.
•Open or close office as shift requires, ensuring that all doors are secured; equipment turned on/off and communicates problems to supervisor in a timely manner. Overseeing the front area for cleanliness, awareness of every visitor, alerting supervisors and management including CEO of any issues.
•Performing general clerical duties including faxing, copying, filing, distribution of memos and daily schedules etc. as needed and maintain needed supplies to conduct daily work. Hostess/Cashier
Jerry's Nugget Casino - North Las Vegas, NV
December 2011 to July 2015
•Hostess and cashier for a 24 hour coffee shop, Italian restaurant, barista/bakery retail and snack-bar attendant.
•Greet guests, inquire about seating preference and take guest to desired seating area.
•Present menus; take reservations and waiting list requests. Open Table system
•Micros register and cash handling, debit/credit transactions, comps, and coupons. Communicate with staff (food servers, managers, cooks and chefs) about guest requests or comments.
•Receive, input, prep and deliver food, desserts and beverages for guest.(Alcoholic and Non Alcoholic)
•Inspect and check thoroughly the restaurants protocols and safety handling procedures in all drinking area stations, front of the house and back of the house.
•Deal with any and all guest complaints with notifying manager and or executives. Behavioral Aide
Bilingual Behavioral Services - Las Vegas, NV
November 2009 to July 2011
•Set up and prepare classroom activities, assignments and or material under the direction of the teacher for the purpose of providing an opportunity for all special education students to participate in classroom activities.
•Confers with teacher, administration, therapies and or participate in team meetings for the purpose of assisting in evaluations in special education clients progress and or implementing IEP objectives.
•Provide verbal and written feedback of observations for the purpose of assisting certified personnel in evaluating client.
•Monitor and assist individual's special education client in the classrooms, playground community outings, public transportation systems, etc. for the purpose of ensuring the safety of assigned students.
•Perform and keep all daily data on instructions and behavior, clerical functions for the purpose of supporting the teacher and administrators in providing necessary records/materials.
•Provide verbal and written feedback of observations for the purpose of assisting certified personnel in evaluating clients.
Medical Records Clerk
Bilingual Behavioral Services - Las Vegas, NV
November 2009 to July 2011
•Initiate medical charts and responsible for routing the chart to the appropriate personnel.
•Pull charts daily for patients who are scheduled and make sure that the date of service is on progress notes.
•Responsible for inserting all documents in patients charts in accordance w/ programs requirements, policies and procedures established at the direction of the clinical staff.
•Pull charts as needed for special audits per review, refill requests and transfer old charts to new charts.
•Place out guide when charts are pulled out.
•Make copies of various forms when required, mail or fax out requests for records when presented w/ a medical request.
•Label new and old charts, filing, scan new files and send to billing department. Busser/Server
Bellagio Hotel and Casino - Las Vegas, NV
September 2008 to February 2009
•Clean, clear and sanitize tables completely and polished silverware.
•Reset tables with clean linens, flatware, glassware and any additional tabletop items needed.
•Pick up and return dirty dishes and glassware to dish room.
•Constantly communicate with servers, hostesses and management to endure tables are turned efficiently.
•Assist with equipment and supplies while following health department guidelines Open Table System.
•Deliver food and drink orders to all areas of the restaurant and bar as well as observe any other reasonable guest request.
Education
High school or equivalent
Chaparral High School - Las Vegas, NV
October 2004 to May 2006
Skills
• Front Desk
• Bilingual
• Front Office
• Reception
• Medical Billing
• Physical Therapy
• Eclinical
• Data Entry
• Medical Office Experience
• Customer Service
• Microsoft Office
• Insurance verification
• EMR systems
• CPT Coding
• OpenTable
• ICD-10
• Medical Records
• Patient Care
• Micros POS
• Experience Administering Injections
• Anatomy Knowledge
• Medical Scheduling
• Medical Terminology
• Medical Coding
• Host/Hostess
• Physiology Knowledge
• ICD-9
• ICD Coding
• Laboratory Experience
• Triage
• Special Education
• HIPAA
• Phone Etiquette
• Medical Imaging
• Transcription
• Epic
• Busser
• Documentation review
• Spanish
• Microsoft Excel
• Microsoft Word
• Microsoft Outlook
Languages
• Spanish - Fluent
Assessments
Medical billing — Proficient
September 2020
Understanding the procedures and forms used for medical billing Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
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