Amber Dyer Ramirez
Merced
Summary
Lead Authorization Specialist skilled in health insurance verification and precertifications, fostering strong relationships with medical professionals and insurance providers. Proven ability to navigate complex insurance processes, ensuring timely authorizations that enhance patient care and operational efficiency.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Lead Insurance Authorization Specialist
El Portal Comprehensive Cancer Center
Merced
03.2021 - Current
- Liaised between oncologists, pharmacies, and insurance providers to secure prompt clearance for chemotherapy administration and radiological procedures.
- Navigate multiple insurance portals and communicate directly with carrier representatives to verify patient eligibility and secure timely medical authorizations.
- Verified patient insurance coverage, determined individual deductibles and co-pays, and logged financial responsibilities into the system to enable efficient front-end collections.
- Serve as primary contact for authorization discussions with Physicians.
- Review denial reasons and advocate for patients while obtaining approval/denial letters, informing the office of results, and providing appeal services.
- Served as a primary liaison to specialty pharmacies, streamlining the prescription authorization and fulfillment process.
- Strong knowledge of insurance payer types and understanding of Medicaid, Medicare, commercial plans and Managed Care Plans, etc.
- Facilitated processing of incoming and outgoing referrals for cross-functional teams to enhance coordination.
- Process medical record requests from patients, insurance companies, and external healthcare providers in a timely, secure, and compliant manner.
- Document and maintain detailed records of all incoming calls, customer concerns, and requests within internal databases.
- Built relationships with physician offices and clinics by initiating contact via email and promptly responding to correspondence within one business day.
Supervisor/ Medical Assistant/ Receptionist/ Authorizations Clerk
Specialists, Inc
Merced
07.2015 - 02.2021
- Supervised employees, managed schedules, optimized office flow, and addressed doctors' needs to enhance operational efficiency.
- Working with students during clinic hours, while adhering with schools' regulations and protocols.
- Knowledgeable in medical terminology, patient (student) charting, vitals, injections, universal precautions, and more.
- Prepared patients for examination by performing preliminary physical tests; taking patient vital signs; reporting patient history summary.
- Coordinated schedules and developed front office receptionists and medical assistants to improve team performance.
- Clean and organize patient rooms to ensure a welcoming environment for incoming patients.
- Conducted electrocardiograms (EKGs) to monitor patients' heart activity.
- Organize and maintain patient medical records to ensure accurate documentation and easy retrieval.
- Dispense prescribed medications to patients according to established protocols and safety guidelines.
- Maintain financial records and organize filing systems to support efficient office operations.
- Measure and record patient vital signs including blood pressure, heart rate, and temperature for health assessments.
- Perform blood draws and administer injections following safety protocols and infection control measures.
- Ability to Follow Verbal/Written Instructions.
- Support physicians in clinical tasks, including preparing examination rooms and assisting with procedures.
- Managed patient scheduling and reception duties to facilitate smooth office operations and enhance patient service.
Education
Some college - General Studies
Merced College
Merced, CA08-2021
High school diploma or GED -
West Park Charter
Fresno, CA05-2013
Skills
- Prior authorization process
- Verification processes
- Insurance verification
- Benefit coverage
- Physician order verification
- Electronic health records proficiency
- Insurance navigation
- Retro-authorizations
- Patient advocacy
- Documentation management
- Client relationship management
- Problem solving
- Attention to detail
- Team collaboration
- Effective communication
Languages
English
Certification
- CPR Certification
- Certified Medical Assistant
Additional Information - Work Authorization
Authorized to work in the US for any employer
Education
High school diploma or GED, Some college
Timeline
Lead Insurance Authorization Specialist
El Portal Comprehensive Cancer Center
03.2021 - Current
Supervisor/ Medical Assistant/ Receptionist/ Authorizations Clerk
Specialists, Inc
07.2015 - 02.2021
Some college - General Studies
Merced College
High school diploma or GED -
West Park Charter