Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Adriana Montesinos

Wheeling,IL

Summary

Capable and professional Referral Specialist. Seeking a position as an Administrative assistant. That will utilize a strong background in efficiently managing multiple priorities and successfully, meeting patient and office demands. Hard working and committed career changer, who is eager to make a positive contribution to your Team. Tenacious Referral Specialist with 6years connecting clients with medical providers. Successful working with insurance companies and other medical professionals to obtain prior authorization and set up essential client appointments. Applies proactive approach to problem-solving and resourceful use of industry network.

Overview

7
7
years of professional experience

Work History

Referral Specialist

Advocate Health Partners
01.2023 - Current
  • Process referrals in a timely, complete, and accurate manner to achieve and maintain exceptional levels of performance that includes customer service
  • Maintains effective communication with referral sources, physicians, Clinical and office staff to ensure adherence to company policies, guidelines, and processes
  • Utilizes critical thinking skills to identify issues and communicate with one up to promote seamless workflow in referral processing
  • Determine if payer's coverage requirements are met for services
  • Follow established department guidelines and procedures to resolve
  • Work manage care claim WQ and process to see if referral was approved or not requested and or deny
  • Work with Claim department with question on referral or to create referral for claim purposes.

Referral Coordinator

Advocate Medical Group
04.2022 - 01.2023
  • Work in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up on specialist service recommended
  • Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines
  • Works with attendings and nurses in the education of physician office staff on referral procedures
  • Verify eligibility of patients
  • Acts as a resource to customers and help resolve referrals, claims and eligibility issues
  • Monitors approval status and resubmit request as necessary for appeals
  • Work with Multiple system to request referral or Prior authorizations
  • Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval.

SBO Custome service rep

Northshore University Health system
12.2021 - 04.2022
  • Take and respond to a high volume of calls each day, providing required information to external agents and patients
  • Collect information regarding delinquent accounts, and arrange for payments, while remaining within the parameters of facility protocols
  • Provide callers with information regarding their statements, and copays, and ensure that any outstanding payments are communicated to them
  • Documents all actions taken into the patient account by writing clear and concise notes into the account
  • Respond to request for addition/deletion of insurance coverage
  • Provided pt
  • With Insurance coverage and explaining EOB from Insurance, claims information.

Patient Service Associate

Northshore
03.2021 - 12.2021
  • Complete patient registration
  • Answer phones
  • Provide other administrative support to the physician practice
  • Verify insurances
  • Check in and check out patients
  • Collect co-payments
  • Premium Finance Processing.

Afco

Premium Finance Processing
02.2020 - 03.2021
  • Process and book new and endorsement agreements within individual approval limits and according to company guidelines
  • Complete post policy verification and insured welcome calls with carriers and insureds
  • Resolve other processing requirements or contract discrepancies by contacting the agent or markets.

Referral Coordinator

Advocate Medical Group
08.2017 - 02.2020
  • Works in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up on specialist service recommended
  • Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines
  • Works with attendings and nurses in the education of physician office staff on referral procedures
  • Verify eligibility of patients
  • Acts as a resource to customers and help resolve referrals, claims and eligibility issues
  • Works with attendings and nurses in the education of physician office staff on referral procedures
  • Monitors approval status and resubmit request as necessary
  • Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval
  • Process Prior Authorization for Radiology test or procedures
  • Work with Multiple system to request referral or Prior authorizations.

Education

Diploma -

Maine East High School

Okton Community college
01.2016

Skills

  • Self-directed

  • Fluent in Spanish and English

  • Strong problem solver

  • Strong interpersonal skills

  • Time Management

  • Knowledge on Health plan insurance Medicare, Medicaid, HMO, PPO, and POS Commercials

  • Team Player

  • Microsoft Outlook, Word, Excel, PowerPoint

  • HIPPA

  • Billing

  • Clerical

  • Follow-up skills

  • Multi-line telephone operation

  • Organizational abilities

  • HIPAA Regulations

  • Customer Service

  • Relationship Building

  • Office Coordination

  • Patient Referral

  • Supply Ordering

  • Computer Proficiency

  • Critical Thinking

  • Documentation Review

  • Medical Records Verification

  • Epic Systems

  • Medical terminology knowledge

  • Pre-authorizations

  • Data entry proficiency

  • Insurance Verification

Languages

Spanish
Native or Bilingual

Timeline

Referral Specialist

Advocate Health Partners
01.2023 - Current

Referral Coordinator

Advocate Medical Group
04.2022 - 01.2023

SBO Custome service rep

Northshore University Health system
12.2021 - 04.2022

Patient Service Associate

Northshore
03.2021 - 12.2021

Afco

Premium Finance Processing
02.2020 - 03.2021

Referral Coordinator

Advocate Medical Group
08.2017 - 02.2020

Diploma -

Maine East High School

Okton Community college

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Adriana Montesinos