Highly organized and results-oriented Payor Specialist Data Analyst with ability to multi-task and prioritize workload. Experienced top professional that successfully support both external clients and internal management. Broad understanding of healthcare data and capable to analyzing problems and designing recommendations including workflows processes and procedures. Devoted to achieving customer satisfaction as well as meeting or surpassing company expectations.
Excellent organizational skills, analytical ability, and strong attention to detail.
Problem Solving Skills.
Outstanding interpersonal and communication skills
Fluent in English and Spanish.
Demonstrated ability to prioritize deliverables
Excellent relationship-building skills.
Ability to excel in team environment.
Strong time management and multi-tasking abilities.
Mount Sinai, Miami Beach, FL
03/2005 to 07/2019
Insurance Authorization Specialist 05/2012 to 07/2019
Successfully reviewed the WQ daily against the EPIC daily census to make sure that new Payor contract has been created for each of the cases requiring follow up.
Effective provided clinical information within the required time frame.
Obtained authorization number successfully for all scheduled procedures within the company and any outgoing orders.
Scheduled procedures once authorization has been obtained.
Insured that all authorizations are up to date and entered into the EMR system.
Worked closely with clinicians and referring providers to obtain necessary information to complete the authorization process.
Confidently and adeptly handled authorization denials and/or appeals.
Kept sensitive customer and company information confidential
Precisely evaluated and verified benefits and eligibly.
Payor Specialist/Medical Data Analyst 03/2005 to 05/2012
Successfully assisted with coordination of the discharge plan,
Effectively coordinated payor requirements at the patient level with the care team that ensures optimum reimbursement and reduced risk of lost days, improving levels of care.
Assisted with data gathering and provides analysis with regard to trends such as LOS, levels of care, and denials (especially by payor and provider)
Supported the clinical care coordinators with clinical denials by developing, implementing and monitoring first and second level appeals.
Reviewed the daily census report to identify new cases, add new cases to payor contract list as open and follows up all pending cases against the appropriate eqhealth report.
Documented the PA numbers under payor contract and closes cases once the authorization numbers and days authorized have been documented.
High School Diploma, Miami Senior High School, Miami, FL
Medical Assistant Diploma, United College/United Business Institute, Miami, FL
Phlebotomy Technician Diploma, America International School, Miami, FL. License Number: 7317980.