Utilization Management Professional with Administrative Expertise
Resume:
Raquel Vazquez
***************@*****.***
PROVIDENCE, Anaheim, California
Utilization Management Assistant, June 2019- October 2024
● Responsible for verification of member’s eligibility and benefits
● Review and assess referrals for completeness
● Identify ICD-10 and CPT codes support referral request
● Assist in gathering clinical information needed to substantiate medical necessity of referral
● Review and authorize procedures on the SJHH Pass-thru and UMA Sign-Off list and escalate to nurse for reviewal if needed
● Communicate with physician offices and other departments as needed
● Process referrals within TAT
● Update patient records with new documentation
● Verify required clinical documentation is complete
● Document all communication in the EMR or UM tracking system
● Monitor daily work queues and worklists
ST. JOSEPH HERITAGE HEALTHCARE, Santa Ana, California Front Office Coordinator, Aug 2015 – Oct 2018
● Answer telephones and direct calls to appropriate staff
● Schedule patient with appropriate Health Educator according to patient’s diagnosis
● Call and confirm patient appointment
● Collect patient payment and balance out cash at end of day
● Update patient’s insurance information and demographics as needed
● Responsible for department’s task bucket list and review referrals received
● Greet visitors, ascertain purpose of visit, and direct them to appropriate staff
● Operate office equipment, such as voicemail messaging systems
● Maintain medical records and correspondence files
● Perform various clerical and administrative functions such as ordering and maintaining an inventory of supplies
ST. JOSEPH HOSPITAL, Orange, California
Medical Records Technician, February 2008- May 2011
● Review patient records for timeliness, completeness, accuracy, and appropriateness of data
● Organize patient’s chart
● Assist in preparing and filing all internal and external correspondence and medical reports into patient’s medical record
● Pick up patient’s discharged charts from medical units, bring back to department, look up patient in EMR system and verify patient is discharged
● Assist Case Management in retrieving medical records needed for reviewal
● Deliver transcribed reports to medical units
EDUCATION
AAPC, Online
Coding- CPC
American Career College, Anaheim, California
LVN Program
ROP, Anaheim, California
Medical Billing and Coding Certificate, 2007
ROP, Anaheim, California
Front Office Medical Assistant, 2006
Savanna High School, Anaheim, California
High School Diploma, June 2006
ADDITIONAL SKILLS
Bilingual in Spanish, self-motivator, great communication skills, interpersonal skills, ability to work well under pressure, adaptability, organization and dependability.
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