Dynamic Lead Certified Medical Assistant with 8 years at Summit Health, excelling in patient care and administrative duties
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 1 year of managing documentation. Considered team player with exemplary multitasking skills.
Essential Skills and Abilities
Bilingual in English and Spanish, proficient in MS Office, and CPR/BLS certified. Known for fostering strong patient relationships and enhancing operational efficiency, ensuring compliance with HIPAA while managing complex insurance inquiries. Completed and submitted clinical submitted clinical documentation following office regulations, and experience in supporting diagnostic and technical treatment procedures.
Overview
9
9
years of professional experience
Work History
Authorization Specialist
Summit Health
07.2024 - Current
Review patient information: Review patient medical history and insurance coverage
Contacting physicians: Contact referring physicians for additional information
Updating patient information: Input new patient information and update existing information
Monitoring schedules: Monitor schedules for potential issues
Performing prior authorizations: Determine if an insurance company covers a given procedure or service
Assessing eligibility: Assess a patient's eligibility for particular services
Communicating with insurance providers: Communicate with insurance providers
Tracking cases: Track the progress of a case
Making outbound calls
Conduct Intake/data entry for prior authorization requests
Review authorization from payer to determine approved/denied items and submit appeals if allowed
Coordinate with providers for further authorization, denial, appeals process information
Providing financial counseling: Offer financial counseling for surgeries and procedures
Lead Certified Medical Assistant
Summit Health
02.2016 - Current
Lead Certified Medical Assistant with 8 years of experience working in a fast-paced environment.
Takes vitals, and assists with all areas of the patient care environment
Handling confidential paperwork, and providing quality patient care.
Team-oriented with a proven ability to create positive rapport with patients, family, and staff
Completed and submitted clinical documentation in accordance with of office regulations, and experience in supporting diagnostic and technical treatment procedures
Experience in supporting diagnostic and technical treatment procedures. Customer-Oriented and self -
Motivated in customer support.
Proficient in medical record -keeping sof tware and MS office.
Thorough attention to detail in daily professional matters
Manage intricate relationships and/or situations involving insurance and financial aid
Utilize and promote protocol enhancements to reply to customer phone, chat, fax, intelligent chatbot, SMS / text, mail, and e-mail requests, as well as other communication channels in a prompt and courteous manner.
Create appropriate documentation and notifications; execute appropriate escalation, monitoring, and follow-up.
Strong critical thinking skills and ability to prioritize effectively
Ability to balance multiple priorities in order to efficiently prioritize tasks and activities.
Patient Service Representative
Summit Health
02.2016 - Current
Patient service support experience in Healthcare for 8 years.
Experience in case management within the healthcare industry such as insurance, reimbursement, co-pay programs and patient assistance programs
Empathetic listening skills and experience in resolving consumer and patient concerns over the phone are essential. Additionally, strong phone and verbal communication skills
Checking in and checking out patients.
Directing and investigating incoming inquiries and/or complaints to the appropriate staff member.
Upholding adherence to HIPAA guidelines.
Training all new patient service representatives and assisting with all questions and concerns.
Reviewing patient accounts, identifying delinquent accounts and collecting amounts that are due.
Processing credit card payments and batching out all incoming cash payments.
Responding and assisting with all patient inquiries and concerns in a courteous and professional manner
Ensuring office is fully stocked weekly, and ordering additional supplies as needed.
Submitting work orders for all maintenance issues.
Assisting Providers and technicians to stay on schedule while ensuring patients are receiving optimal care.
Ensuring employees uphold the time and attendance company policy.
Scanning all pertinent incoming patient information into the patient’s chart.
Education
BBA - Bachelor of Business Administration Health Service
Berkeley College
Woodland Park,NJ
04-2025
Skills
Software: MS Office
Athena
Bilingual- English/ Spanish
Medical Terminology
CPR/BLS certified
Customer Service
Timeline
Authorization Specialist
Summit Health
07.2024 - Current
Lead Certified Medical Assistant
Summit Health
02.2016 - Current
Patient Service Representative
Summit Health
02.2016 - Current
BBA - Bachelor of Business Administration Health Service
Berkeley College
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