Data Entry Customer Service

ELOISA G. SANTOS

**** ********** **

SAN ANTONIO, TEXAS 78221

210-***-****

MEDICAL BUSINESS TECHNOLOGY

Medical Administrative professional with increasingly responsible position in health care provider relations and insurance, including extensive background in insurance billing, data entry and coding. Offering expertise in posting payments, verifying customer/client information, customer service (Right Fax), workflow coordination, patient registration and hands on computer support skills in LCD-9, CPT Code and Microsoft Word. CAREER HISTOY

Program Coordinator I

Superior Health Plan, San Antonio, Texas 78230 2013 – 2024 Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census. Screen for eligibility and benefits. Identify members without a PCP and refer to Member Service. Screen members by priority for case management (CM)assessment. Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs. Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Procedures and mails routine CM letters and program educational material. Data enter assessments and authorizations into the system. Ancillary Coordinator

Gonzaba Medical Group, San Antonio, Texas 78214 2009 – 2012 Collects, verifies and enters demographics and insurance information into the system on new and established patient accounts as requested directly or indirectly by receipt of scheduled appointments. Obtains insurance information necessary for various clinical services or procedures. Verifies patient eligibility and benefit package information via phone or online resources. Advises patients and clinical staff regarding patient’s financial responsibilities and explains co-payment collection, deductibles and the billing process based on the patients financial status classification (FSC). Obtains needed information from PCP and HMO payers to initiate managed care authorizations/pre- certification allowing no more than 48 hours for completion. Make appropriate notations in the system in regards to actions taken and insurance verification and authorizations. Authorization Coordinator

United Health, San Antonio, Texas 78249 2005 – 2008 Performed a range of administrative and medical coordination duties. Inputs and processes authorizations per guidelines and according to defined time and accuracy standards. Maintains effective communication with inpatient facilities, providers, and other UM/CM staff. Administers reports, & maintains files, correspondence, denial & appeal logs, and documentation of materials to support report stats & clinical workflow. Ensures correct and consistent application of decision support system. OTHER RELEVANT EXPERIENCE:

Referral Coordinator/Client Spec Humana Insurance 1998 - 2005 Part-Time File Clerk (Radiology) University Hospital 1993 - 1994 Billing Clerk (Ob-Gyn) University of Texas Health Science Center 1992 - 1993 Account Clerk I La Clinica Amistad, Inc. 1990 - 1992 Part-Time File Clerk (Radiology) University Hospital 1989 - 1990 Receptionist Judson-Atkinson Candies, Inc. 1985 - 1989 Part-Time File Clerk/Typist Kelly Air Force Base 1983 - 1984 Education and Professional Development/Training

HIPAA Training (update) – 2002

South San High School, Graduate (1984)