PATRICIA A. REA

***** **** **** **.

San Antonio, TX 78249

210-***-****

adm4w9@r.postjobfree.com

Areas of Expertise

Professional Certified Medical Claims and Billing Specialist

Strong knowledge of administrative and clerical processes

Highly skilled in multi-tasking

Exceptional customer service practices

Bilingual (English/Spanish)

Trained and knowledgeable of expansive electronic medical records (EMR), ICD-10 and CPT codes, medical claims and Billing Software (Advanced MDI, MDI, Artiva, Centricity, E-Clinical, Availability Nov-Net Tri- Zetto Lytec Moms Systems, and Anthen and NextGen Cmed system) and Microsoft Office programs Trucare, Ika-Claims.

Work Experience

Contracted UM Coordinator Prior Authorization Team– United Health Group Feb. 2020 – Aug.2020

Review incoming faxes from providers and build hospital intake or observation authorizations per the member’s provider requests

Processes referrals, and build prior authorizations for providers, including intake, notification and census roles

Works with hospitals, office visits, Referrals, PCP, Surgeries facilities and the clinical team to manage requests for services from members and/or providers

Responsible for verifying patient-eligibility, coordinating benefits, and facilitating insurance coverage

Skills in gathering, analyzing and evaluating patient information

Review daily faxes intakes for IP- inpatient Hint OBS, Admin, discharge and PA-OP-outpatient, Retro referrals for services that were rendered either office visits or outpatient surgical procedures.

Utilizes and understands ICD-10 and CPT codes

Medical Records Specialist – South Texas Radiology Imaging Center (STRIC) March. 2019 – Feb, 2020

Gathers patient information by collecting demographic information from a variety of sources

Retrieve corporate documents, records, and reports from various doctors’ offices and hospitals

File incoming correspondence, including faxes, and emails with patient information

Communicate with customers effectively to provide adequate customer service

Provide Medical Records support to other departments

Create work orders, burn CD’s, and scan documents

Efficient with using Windows Risk AGFA and Meditec Short Keys programs

Customer Service Representative – City of San Antonio Jan. 2018 – Feb. 2019

Approve, schedule, and scan engineering documents

Assist customers in obtaining permits

File paper work and incoming mail

Scheduling appointments and meetings for inspectors

Communicate with customers

Distribute tickets and applications to customers

Listen to audix to schedule inspectors

Provider Utilization Coordinator – QTC Nov. 2016 – Dec.2017

Support VAO operations

Effectively utilize reports and tools to communicate IPA schedules to providers

Responsible for building and adjusting provider’s schedules

Prioritize operations and provider’s requests when necessary

Proactively communicate issues/concerns with leadership teams

Efficiently utilizes electronic tools and workflows in order to manage resources

Medical Office Specialist – Methodist Cardiology Clinic of San Antonio Mar. 2016 – Sept. 2016

Scheduled hospital surgeries and testing

In charge of patient registration, patient check in and patient check out and In-bound

Answered phones and sent fax requests to doctors and hospitals

Pre-Authorization

Prepared patient charts for filing

Handled medical record request

Insurance verification and referrals

EMR-NEXTGEN

Underpayment Analyst - Parallon/HCA Jan. 2015 – Dec. 2015

Generated letters to individual medical insurances regarding underpayments or denials that required appeal

Ensured prompt and effective follow-up to recover accurate payments

Analyzed patient hospital claims in regards to expected reimbursement based on managed care contract terms and regulation and accurately following up on appeals to ensure timely collections on underpaid or denied claims

Administrative Assistant C.E.O. - C.J. Machine Inc. April. 2012 – July. 2014

Greet Customers, Patrons, or Visitors, Answer telephones to direct calls or provide information.

Perform general office duties, such as ordering supplies, maintaining records management database systems

Order materials, supplies, or equipment

File and retrieve corporate documents records, and reports

Open, sort, and distribute incoming correspondence, including faxes and email

Provide Administrative support to other departments

Medical Records Specialist - Heart & Vascular Institute of Texas Oct. 2009 – Jun. 2011

Handled medical record request

Medical Claims and billing

In charge of patient registrations and patient check out

Collected Co-Payments

Prepared patient charts and filing

Insurance verification and referrals

EMR/Athena Net

Front Office Receptionist - Carrasco Pain Institute Sep. 2008 – Oct. 2009

Workmen’s Compensation billing

Insurance verification and referrals

Scheduled and confirmed patient appointments

In charge of patient registration and patient check-out

Medical Claims and billing

Customer Service Rep - USAA Federal Saving Bank Mar. 2007 – Feb. 2008

Assisted members with inquires and transactions

Provided Customer support for the call center

Assisted with research, analysis and resolved member account concerns

Contacted members that had delinquent accounts

Education

McCollum High School, San Antonio, Texas Class of 1985

Professional Medical Claims & Billing Program Certified 2004

Professional References

Edward Trevino: 210-***-****

Melissa Garza: 210-***-****

Minnie Arispe: 210-***-****

Becky Del Toro 210-***-****

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