Commercial Insurance Follow Up/Scheduling

Richard A. Alfaro

CLAIMS ANALYST/REFERRAL SPECIALIST

Tyler, TX 903-***-**** **************@*****.*** Experience

Tyler Family Circle of Care -04/2024 - Present

• Processed specialist referrals

• Use of AVAILITY, EPIC, and various major commercial insurance websites

• Contacted Patients and Specialists for either appointments to be scheduled or follow up with Specialists. Extensive Medicaid specialization

• Obtained Authorizations and Appealed denied authorizations UT Health East Texas 03/2023 - 04/2024

• Processed specialist referrals

• Use of AVAILITY, EPIC, and various major commercial insurance websites

• Contacted Patients and Specialists for either appointments to be scheduled or follow up with Specialists

• Obtained Authorizations and Appealed denied authorizations Christus Trinity Hospitals/Clinics 06/2021 - 03/2023; 06/2002-04/2008

• Processed specialist referrals faxed in queue using the EPIC system

• Verification of medical insurance and obtaining Authorizations or Precertification if needed • Registered and scheduled patients

• Cost estimates for offices visits calculated

Centene 11/2018 - 06/2021

• Processed and calculated Wellcare medical claims to be either Paid, Denied or needing further review. Worked with Medicare and Medicaid in the Coordination of Benefits COB Education

Tyler Junior College Associate of Arts 1974-1976

Degree awarded 1976

Kilgore College, AAS Process Technology 2012

Phi Theta Kappa Degree awarded 2012

University of Texas Tyler BA Industrial Technology (in process) Major: Nanotechnology Minor: Computer Science

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