Adriana Teposte
Ingelwood ,CA
Summary
Dedicated administrative professional well-versed in communication and team building. Knowledgeable in medical terminology and scheduling. Ready to bring 20 years of relevant work experience to your team. Capable Patient Representative dedicated to providing superior support for patients in need of reliable information regarding insurance coverage, finance options and documentation requirements. Well-versed in scheduling and database management functions for streamlined communication and reduced correspondence backlogs. Excels at identifying client needs and concerns to improve engagement strategies and overall service.
Overview
19
19
years of professional experience
Work History
Prior Authorization Specialist
UCLA Health/ Department Of Cardiovascular
08.2016 - 08.2023
- Communicated with insurance companies to verify patient coverage, obtain authorization for special testing, or referrals
- Verifying insurance coverage by phone and online to ensure proper coordination reimbursement of benefits and estimates of patients' financial responsibilities of commercial, governmental and third party insurances
- Handling insurance policies with strong knowledge of ICD-9, CPT-10, Medical terminology and HIPPA regulations
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high-volume insurance verification's within pressured time frames for productive medical operations.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Assisted providers initiating and completing prior authorizations for patient medications.
- Provided customer service to members, providers and pharmacist with authorizations status, re considerations, appeal process, and medication overrides.
- Researched issues and provided resolutions if applicable.
- Update patient demographics and insurance information.
- Daily interaction with other departments to assist patients and providers with problems or questions and act as a facilitator to resolve questions or concerns.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
Call Center Representative
UCLA Medical Center
11.2008 - 08.2016
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Documented and detailed calls and complaints using call center's CRM database.
- Performed various clerical duties by filing and faxing documents and creating customer databases.
- Demonstrated strong problem-solving skills by resolving customer issues during first call.
- Sought out extra training opportunities to enhance customer relationship management abilities.
- Met customer call guidelines for service levels, handle time and productivity.
- Investigated and resolved customer inquiries and complaints quickly.
- Educated customers about billing, payment processing and support policies and procedures.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Trained new personnel regarding company operations, policies and services.
Front Desk Receptionist
UCLA Health/ Department Of Dermatology
04.2006 - 11.2008
- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Received and sorted incoming mail and packages to record, dispatch, or distribute to correct recipient.
- Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
- Maintained organized and clean front office area to create professional and welcoming environment for visitors and employees.
- Scheduled, coordinated and confirmed appointments and meetings.
- Assisted internal staff with clerical and administrative needs to maximize efficiency and team productivity.
- Collected co- payments, processed transactions and updated relevant records.
File Clerk
UCLA Medical Center
09.2004 - 04.2006
- Assisted with data entry and administrative support tasks to help meet team goals
- Sorted and classified documents into appropriate filing systems for increased traceability.
- Assisted with document scanning and imaging projects to support accurate file back-up.
- Restored old files and archived completed files for future reference.
- Created and printed labels for well-organized filing.
- Processed payments, issued receipts and updates invoices to assist with financial record keeping.
- Created, implemented and monitored filing systems for easy retrieval of records.
- Tracked file removals and coordinated on-time returns.
Education
High School Diploma -
06.2004
Skills
- Ability to communicate professionally and effectively
- Excellent organizational skills and ability to prioritize assignments
- Ability to manage multiple responsibilities at once by focusing on one task while keeping track of others
- Ability to maintain high level of confidentiality and professionalism
- Skilled in optimizing workflow efficiency, prioritizing tasks, and meeting deadlines without compromising quality
- Demonstrated ability to work effectively between teams and maintaining positive dynamics
- HIPAA trained
- Medical terminology knowledge
- Proficient in Microsoft Windows, Office, Word, Outlook, Team
Timeline
Prior Authorization Specialist - UCLA Health/ Department Of Cardiovascular
08.2016 - 08.2023
Call Center Representative - UCLA Medical Center
11.2008 - 08.2016
Front Desk Receptionist - UCLA Health/ Department Of Dermatology
04.2006 - 11.2008
File Clerk - UCLA Medical Center
09.2004 - 04.2006
Venice High - High School Diploma,
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