AIME FELIX CASTRO
Spring Valley,United States
Summary
Detail-oriented professional with strong analytical, communication, and teamwork skills. Proven ability to adapt quickly to new environments. Eager to contribute to team success and further develop professional skills. Brings a positive attitude and commitment to continuous learning and growth. Can handle multiple tasks effectively and efficiently in fast-paced environments.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Child and Family Specialist
Rady Children's Hospital Of San Diego
03.2024 - Current
- Collaborated with interdisciplinary teams to provide comprehensive support for families in crisis situations.
- Enhanced family dynamics by conducting comprehensive assessments and developing individualized service plans.
- Promoted child well-being by connecting families to essential community resources and support services.
- Built and maintained strong partnerships with community organizations to support the diverse needs of families served, increasing access to vital resources.
- Maintained accurate case records, ensuring efficient documentation for ongoing monitoring and progress evaluation.
Patient Access Representative
Rady Children's Hospital Of San Diego
10.2022 - 02.2024
- Provided crisis intervention support during emergency situations, helping families regain stability following critical incidents.
- Adapted quickly to changing demands within the healthcare environment, demonstrating flexibility and a strong commitment to quality patient care.
- Ensured compliance with HIPAA regulations to maintain confidentiality of sensitive patient information during all interactions.
- Facilitated smooth billing processes by verifying insurance eligibility, obtaining authorizations, and accurately entering claim details into the system.
- Assisted with administrative tasks such as filing, data entry, and report generation to support streamlined office operations.
- Developed proficiency in various healthcare software programs for accurate documentation of patient encounters and streamlined workflows within the department.
- Managed challenging situations effectively by remaining calm under pressure while resolving conflicts or addressing dissatisfied patients professionally.
Authorization Specialist
Imaging Healthcare
07.2018 - 10.2022
- Enhanced overall patient experience with empathetic communication and thorough explanations of insurance benefits and coverage.
- Experience with HMO, PPO, Medicare, Medi-cal, Work Comp Insurances.
- Submitted authorizations via portals, written, phone call (if needed).
- Followed up with insurances to verify patient benefits, and payments due at time of service.
- Helped our Authorizations department while working with IT and upper management complete transfer from Merge Ris to Royal Pay.
- Became a super user and key component available for the team if questions occurred.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology.
- Obtained authorizations from various insurances and for different providers.
- Responded to inquiries efficiently in regard to current status of authorizations by reviewing the request and evaluating the circumstances to provide the needed information.
- Coordinated with other healthcare personnel to deliver quality patient care.
- Explained imaging procedures to patients, offering comfort and assistance.
- Complied with HIPAA and company regulations to maintain confidentiality regarding patient health data and medical records.
Authorization Specialist
Arch Health Medical Group
09.2017 - 07.2018
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Communicated with people from various cultures and backgrounds on application process.
- Trained staff on current eligibility requirements and policies.
- Engaged wider departments in accurate, timely paperwork completion.
- Established databases to track, analyze and automate eligibility application processes.
- Attended ongoing professional training to facilitate accurate and productive credit management.
Education
Administrative, Medical Insurance Billing -
Brightwood College
07.2015
High School Diploma - undefined
Diego Hills
06.2013
Skills
- Mental health awareness
- Prior authorization processing
- Data entry proficiency
- HIPAA compliance
- Claims management
- Medical terminology expertise
- Insurance verification
- Recordkeeping and data input
- Needs Assessment
- Empathy Training
- Community Resources
- Case Management
- Training & Development
Certification
- Victim Assistance Training Online, 41 hours
- Child Abuse & Neglect Mandated Reporter, 4 hours
- CalTrin Intro to Child Trauma Certification
- Cultural Competency Certification
- Domestic Violence essentials Training, 6 hours
Languages
Spanish
Native or Bilingual
Timeline
Child and Family Specialist
Rady Children's Hospital Of San Diego
03.2024 - Current
Patient Access Representative
Rady Children's Hospital Of San Diego
10.2022 - 02.2024
Authorization Specialist
Imaging Healthcare
07.2018 - 10.2022
Authorization Specialist
Arch Health Medical Group
09.2017 - 07.2018
High School Diploma - undefined
Diego Hills
Administrative, Medical Insurance Billing -
Brightwood College
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