Administrative assistant, Program Coordinator, Customer service, Staf
Resume:
Jacqueline Rivera
***********@*****.***
PROFESSIONAL PROFILE
• Over 20 years experience with insurance authorization process
• Assisted clinical workers with authorizations and maintaining authorization lists
• Trained new authorization/referral
coordinators
• CPT and ICD-9 coding
experience
• Read, write, and speak English and Spanish
fluently
• Trainer for Outpatient/Emergency
Departments
• WPM: 50 words
PROFESSIONAL EXPERIENCE
Village Medical Center Sept 2021 to Present
Referral Coordinator/Scheduler
• Assists patients calling or visiting the clinic
• Initiate referrals process and evaluated requirements for each referral per protocol
• Made referral appointments and maintains referral log in Dashboard per policy
• Assists with call backs to patients, insurances, and outside providers when referring to any and all referrals.
• Assists with call backs to patient at provider request
• Maintains daily EHR worklist
• Enter patient data into clinic tracking system
• Tracked in a timely manner per procedure
• Strategically plan appointments for patients
• Answered phone calls and email in a timely manner
• Schedule appointments for Home Health, DME and Wound Care Sunshine Health Oct. 2017 to March 2021
Program coordinator II
● Perform duties to assist in activities related to the medical and psychosocial aspect of utilization and coordinated care.
● Initiate authorization information pertaining to special needs.
● Coordinate services with community base organization.
● Data entry assortments into the system.
● Screen for eligibility and benefits.
● Identify members without PCP and refer to member services.
● Screen members by priority for case management assessment. Perform transition care duties to include but not limited to, contact the members attending physician, member or medical power of attorney, other medical providers (Home health agencies, equipment vendors) for information pertaining to special needs.
● Maintain databases and date enters assessments and authorization into the system.
● Assist with developing marking and outreach meetings. Memorial Healthcare System 04/1999 to 08/2017
Patient Financial Representative
• Demonstrate ability to obtain and initiate
authorizations
• Expected to complete up to 80 accounts daily including verifying insurance, updating demographic information, and processing authorizations
• Expected to complete a high volume of inbound/outbound calls daily as well as collect 7,000 monthly
• Demonstrate the ability to maintain medical
records
• Extensive data entry including correcting and verifying medical coding for authorizations, patient demographic information, and updating patient records for services
• Obtains ongoing authorization according to plan care within 48 hours of visit.
• Call insurance companies or doctors as needed for authorizations prior to initial appointment.
• Record authorization on chart and in computer
system.
• Inform patient of their financial responsibility when insurance denies treatments or if unable to get authorizations.
• Demonstrate the ability to interview patients and/or their representatives to obtain necessary information:
• Complete preadmission registration accurately and expeditiously prior to the date of initial appointment
• Verify injury date, diagnosis, correct insurance code, and verify insurance company at time of pre- admission and registration.
• Obtain all required signature according to hospital, state, and federal policy.
• Discharge patient from the
computer.
EDUCATION
High School Diploma
Dr. Jose M. Lazaro High School
References Available Upon request
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