Administrative & Insurance Authorization Specialist
Resume:
Rachael Martinez
San Angelo, TX *****
************@*****.***
Professional Summary
Administrative and Office Services Professional, which is well-respected for the ability to take initiative, multi-task, and manage projects. Provides excellent organizational, communication, customer service skills; as well as attentive to detail, able to quickly and effectively prioritize to meet deadlines. Experienced PC Proficient with Microsoft Office Suite, QuickBooks, and other specialized software products as ECW, AthenaHealth, EPIC, LeadingReach, Availity and OneSource; as well as strong accounting and mathematical computation skills.
Willing to relocate to: San Angelo, TX
Authorized to work in the US for any employer
Willing to relocate to: San Angelo, TX - San Angelo, TX Authorized to work in the US for any employer
Work Experience
Insurance Verification Specialist
Heart and Vascular Partners-Colorado Springs, CO
July 2024 to Present
Position consists of acquiring authorizations of approval or denial for referrals. Place calls to insurance companies to obtain verification and authorization codes. I call or use portal to verify eligibility and benefit stays. Submitting referrals electronically to rendering or requesting providers once approved, denied or missing information. I would place calls to prescribers or patients also send and receive faxes regarding prior authorization information and forms. I submitted authorizations for Cardiology procedures and diagnostic imaging.
Insurance Authorization Specialist
Cardiology Associates of West Texas-San Angelo, TX December 2023 to February 2024
Position consists of acquiring authorizations of approval or denial for referrals. Place calls to insurance companies to obtain verification and authorization codes. I call or use portal to verify eligibility and benefit stays. Submitting referrals electronically to rendering or requesting providers once approved, denied or missing information. I would place calls to prescribers or patients also send and receive faxes regarding prior authorization information and forms. I would create estimates for new OB patients and collect payments. I covered OB/GYN, Radiology, High Cost Meds, Pain Management and Cardiology. Insurance Authorization Specialist
Shannon Medical-San Angelo, TX
April 2023 to December 2023
Position consists of acquiring authorizations of approval or denial for referrals. Place calls to insurance companies to obtain verification and authorization codes. I call or use portal to verify eligibility and benefit stays. Submitting referrals electronically to rendering or requesting providers once approved, denied or missing information. I would place calls to prescribers or patients also send and receive faxes regarding prior authorization information and forms. I would create estimates for new OB patients and collect payments. I covered OB/GYN, Radiology, High Cost Meds and Pain Management. Remote - Prior Authorization Specialist
Asembia - ASPN Pharmacy-Livingston, NJ
August 2022 to December 2022
Position consists of acquiring authorizations of approval or denial for referrals. Place calls to insurance companies to obtain verification and authorization codes. Submitting referrals electronically to rendering or requesting providers once approved, denied or missing information. I would place calls to prescribers or patients also send and receive faxes regarding prior authorization information and forms. Prior Authorization Specialist
Austin Diagnostic Clinic-Austin, TX
August 2021 to June 2022
Position consists of acquiring authorizations of approval or denial for referrals. Place calls to insurance companies to obtain verification and authorization codes. Submitting referrals electronically to rendering or requesting providers once approved, denied or missing information. I would place calls to prescribers or patients also send and receive faxes regarding prior authorization information and forms. Front Desk Receptionist
Family First Health Care - CPRMC-Leander, TX
July 2019 to June 2021
Position consisted with check in/out patients, collecting copays, presenting patient with forms, update patient demographics, verify insurance, scheduling/rescheduling appointments, place reminder calls, send and receive faxes to scan into patient chart, receive and place calls to patients for various information and assisted Spanish speaking patients. Non-Clinical LVN
ADDISON GROUP-Austin, TX
January 2018 to December 2018
Position consisted with check in/out patients, collecting copays, presenting patient with forms, update patient demographics, verify insurance, scheduling/rescheduling appointments, place reminder calls, send and receive faxes to scan into patient chart, receive and placed calls to providers requesting patient medical records, assisted in rooming patients, and assisting patients in STAT situations at the Doctors request.
Patient Service Specialist I
BAYLOR SCOTT AND WHITE HOSPITAL-Round Rock, TX
January 2016 to December 2018
Position consisted with check in/out patients, collecting copays, presenting patient with forms, update patient demographics, verify insurance, scheduling/rescheduling appointments, place reminder calls, send and receive faxes to scan into patient chart, receive and place calls to patients for various information, created/verified referrals, and assisted patient with locations to various departments. Office Manager
MEGS INC-Leander, TX
January 2004 to December 2010
Provided in a series of increasingly responsible administrative and office services positions. Scope of responsibility was diverse and included managing customer service, coordinating complex data collection, and reporting, typing correspondence, maintaining/updating records, monitoring office inventories, assisting with general accounting and payroll processing, planning meetings, and providing general administrative support. Attended a QuickBooks training course and set up the program for company Payroll process.
Education
Health Administration with a Concentration in Healthcare Management Certificate (Bachelor's of Science)
University of Phoenix-Austin, TX
March 2013 to May 2016
Health Care Administration (Associate of Arts)
University of Phoenix-Austin, TX
August 2010 to February 2013
High School Diploma
Central High School-San Angelo, TX
1993
Some college
High school diploma or GED
Bachelor's degree
Skills
• Front desk
• Dermatology
• Contracts
• ICD-9
• Anatomy knowledge
• Cerner
• Insurance verification
• Medical billing
• Document management
• Record keeping
• Utilization management
• Medical billing account reconciliation
• Spanish
• Banking
• Databases
• Teamwork
• Process improvement
• Microsoft Publisher
• Insurance claim appeals processing
• Medical payment processing
• EMR systems
• Microsoft Access
• Insurance medical billing
• Patient collections management
• Applied behavior analysis
• Data analysis skills
• Adobe Acrobat
• Data entry
• Technical support
• Bank Secrecy Act
• Cash management
• Research
• Clinic administrative experience
• Sales
• Medical Scheduling
• Computer networking
• Patient monitoring
• eClinicalWorks
• Client services
• Experience Administering Injections
• Microsoft Outlook
• Medical coding software
• Medical Records
• Outpatient
• Clerical experience
• EHR systems (7 years)
• Analytics
• Order fulfillment
• Search engines
• Appeals
• Accounting systems
• Leadership
• Organizational skills
• ICD-10
• HIPAA
• Athenahealth (2 years)
• EMR Systems
• Data Entry
• Medical coding
• Accounting
• Supervising experience
• Negotiation
• Insurance prior authorization
• Medical office management
• Analysis skills
• ICD coding
• Grammar Experience
• Conflict management
• Patient appointment follow-ups
• Medicare
• Accounts receivable
• Medical administrative support - Medical administrative support experience (6-10 years)
• Office management
• Proofreading
• Patient scheduling systems
• Medical Office Experience
• Behavioral health
• Ob/Gyn
• Familiar June 2021 Measures the traits that are important for successful administrative support professionals Full results: Familiar Administrative assistant/receptionist
• Proficient July 2019 Using basic scheduling, attention to detail, and organizational skills in an office setting. Full results: Proficient Customer focus & orientation
• Information security
• Utilization review
• CPT Coding
• iOS
• Root cause analysis
• Quality control
• Records management
• Transcription
• Live chat
• Productivity software
• Customer support
• Patient referrals
• Maintaining patient confidentiality
• Triage
• 10 key typing
• Handling patient inquiries
• IT
• Visio
• Healthcare management
• Microsoft Office
• Salesforce
• Human resources
• Revenue cycle management
• Communication skills
• Medical records
• Heavy lifting
• Epic
• Computer Operation
• Medical Terminology
• Administrative Experience
• Phone etiquette
• Project management
• Anatomy Knowledge
• Documentation Review (7 years)
• Microsoft Excel
• Electronic health records (EHR) management
• Fluent Filing & organization
• Managing patient records
• Quality audits
• Completed June 2021 Using basic scheduling and organizational skills in an office setting Full results: Completed Customer service
• Clinic
• Documentation review
• Test-driven development
• SharePoint
• Patient insurance coordination
• Medical Coding
• ICD Coding
• EMR systems (7 years)
• Familiar June 2021 Responding to customer situations with sensitivity Full results: Familiar Attention to detail
• Google Docs
• CPT coding
• Computer skills
• Phone answering
• Calendar management (Less than 1 year)
• Patient management software
• Familiar February 2019 Identifying differences in materials, following instructions, and detecting details among distracting information. Full results: Familiar Administrative support professional fit
• Electronic Health Record (EHR) access control systems
• Highly Proficient June 2019 Arranging and managing information or materials using a set of rules. Full results: Highly Proficient Receptionist
• Google Suite
• Regulatory compliance
• Lead generation
• Office experience
• Microsoft Word
• Managing healthcare administrative teams - Largest healthcare administrative team managed (6-10 team members)
• Time management
• Recruiting
• Medical software
• Team management
• Hospital experience
• Software troubleshooting
• Writing skills
• Math
• Patient complaint handling
• Quality Assurance
• Inpatient
• Payroll
• Billing troubleshooting
• Medical insurance appeals management
• QuickBooks
• Financial services
• Customer service
• Achieving HIPAA compliance
• Microsoft Powerpoint
• Cold calling
• Affordable Care Act (ACA)
• Presentation skills
• Data management
• Windows
• Quality assurance
• Medical terminology
Languages
• Spanish - Intermediate
• English
• Bilingual
Certifications and Licenses
Healthcare Management Certificate
Present
I received a Bachelor's of Science in Health Administration with a Concentration in Health Management Certificate. With this certificate and studies it would prepare me to one day become a Healthcare manager.
CMOM
Epic Certification
CPR Certification
Non-CDL Class C
Professional In Human Resources
Driver's License
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