ANDREA ESCOBAR-JIMENEZ
Summary
Customer-focused healthcare professional with demonstrated accountability for effectively handling incoming and outgoing calls related to insurance benefits from internal team members, insurance payers, and customers. Identify and update important patient and demographic information. Validate patient's insurance plans, prescriptions and eligibility. Maintain professional, positive and effective communication with customers, doctor offices, and insurance companies.
Experienced with in-depth knowledge of subject matter, ensuring accurate and effective guidance. Utilizes critical thinking and problem-solving skills to address complex challenges. Track record of effective communication and collaboration in diverse team settings.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Subject Matter Expert- Remote
Asembia
12.2023 - Current
- Conducted thorough assessments to identify knowledge gaps within the team.
- Facilitated knowledge-sharing sessions to promote continuous learning within the organization.
- Increased employee engagement with comprehensive workshops on subject matter expertise.
- Streamlined processes by implementing standardized procedures based on industry benchmarks.
- Mentored junior team members, contributing to their professional growth and development.
- Improved team performance by providing expert guidance and support on industry best practices.
- Established best practices for knowledge sharing, fostering a culture of continuous learning and improvement.
- Developed effective training materials for diverse audiences, resulting in improved skillsets and increased job satisfaction.
- Streamlined processes to increase efficiency, enabling teams to complete tasks ahead of schedule.
- Enhanced team performance by providing expert guidance on critical projects and strategic initiatives.
- Enhanced client relationships by delivering tailored advice and demonstrating in-depth product knowledge.
- Led cross-functional teams to deliver projects within tight deadlines, maintaining keen focus on quality.
Patient Care Coordinator- Remote
Asembia
12.2023 - Current
- Responsible for executing program requirements, managing daily workflow, providing accurate and complete data input, managing pre-certifications and providing high levels of customer service
- Complete prescription intake process including verification of insurance coverage
- Assist physician's offices through the prior authorization and appeals process
- Research financial assistance options for patients through copay cards, foundations, and assistance programs
- Coordinate prescription processing and delivery with dispensing pharmacies
- Manage and triage high volume of customer service phone calls while managing day to day operations
- Build relationships with physicians, manufacturer sales representatives, pharmacies, patients, and other team members to optimize workflow and achieve program goals
- Ensure proper documentation of process flow from prescription initiation through completion
- Provide timely updates to physicians, pharmacies, and manufacturers regarding prescription status
- Interface with IT department to improve system functionality and workflow
- Attend team meetings to support ongoing program development
- Maintains database by entering new and updated customer and account information
- Processes customer and account source documents by reviewing data for deficiencies
Prior Authorization Specialist - Remote
GoodRx
10.2022 - 12.2023
- Responsible for submission/follow up of requests to ensure timely turnaround/approval and resolution, for vitaCare Prescription Services division (acquired by GoodRx)
- Prior Authorization Process
- Customer Care Advocate
- Medical / Insurance Processing
- Problem Resolution / Troubleshooting
- Healthcare Support Specialist
- HIPAA Mastery
- Data Entry / Documentation
- Collaborative Team Leadership / Training
- Contacted insurance carriers to verify patient's insurance eligibility, benefits and requirements
- Requested/tracked/obtained pre-authorization from insurance carriers/doctor's offices within time allowed for medical and services
- Demonstrated knowledge of medical terminology, and high proficiency of general medical office procedures including HIPAA regulations
- Exceeded productivity standards for the department while communicating changes/trends to team
- Clearly documented all communications/contacts with providers and personnel in standardized documentation requirements
- Effectively utilized EMR and online authorization sites for medication programs
- Assisted with medical necessity documentation to expedite approvals and ensured appropriate follow-up was performed
- Reviewed/followed up on denials with provider to obtain necessary information to submit appeal
Customer Care Advocate - Remote
GoodRx
02.2021 - 12.2023
- Provided timely responses to customer inquiries regarding product/service questions, billing, processing Rx orders and technical concerns/issues
- Opened/maintained customer accounts/records by recording and updating account information; processed customer adjustments
- Resolved product/service problems by clarifying customer's complaint, determining the cause of the problem, recommending best solution, expediting correction/adjustment, and following up
- Recommended potential products/services to management by collecting/analyzing customer information and needs
- Collaborated cross-functionally regarding billing questions, technical support, and training
- Accountable for overseeing team chats/message activities/questions and distributing information to team members; provided direction and motivation to fellow coworkers/new employees
Medical Assistant
Academic Alliance of Dermatology
06.2020 - 02.2021
- Scheduled/confirmed appointments, checked patients in and out, pulled charts, verified insurance coverage, and called in prescriptions
- Worked with pediatric/adolescent/adult/geriatric patients
- Roomed patients, prepared charts, and detailed patient assessments and histories
- Performed injections, punch and shave biopsies, LN2 treatments, wound treatments, Autoclaving, and surgical prep
- Input clinical notes, demographics, and insurance information into computer system utilizing CareCloud HER, Next Tech software
Medical Assistant
B3 Medical, Interventional Pain Management
11.2019 - 06.2020
- Handled Prior Authorizations with no supervision
- Dispensed/disposed of medications
- Accountable for: patient intake information, vitals, urine/oral swab analysis, Toradol injections
- Worker's Compensation, medication reconciliation and inventory
- Trained employees through shadowing and demonstrating step-by-step company processes
- Cleaned/stocked exam rooms
Medical Assistant / X-Ray Technician
Cortez Foot & Ankle Specialists
05.2018 - 11.2019
- Explained procedures to patients to reduce anxieties and increase patient cooperation
- Obtained client medical history; conducted preliminary evaluations and documented results with accuracy
- Documented vital signs/health history for 120 patients daily
- Updated inventory, expiration and vaccine logs to maintain current tracking documentation
- Prepared lab specimens/cultures for diagnostic evaluation
- Prepared patients for X-rays, suture removal and dressing changes
- Worked with patients with pain management and chronic pain
- Scheduled Physical Therapy/MRI appointments
- Arranged surgeries with surgical center, confirming times, preparing admission and consent forms
Customer Care Representative
Hamilton Relay
11.2017 - 05.2018
- Managed heavy volume of inbound and outbound calls in a timely manner
Caregiver
Dream Team of LA, Inc.
10.2013 - 11.2017
- Assessed medical needs and prepared a care plan for patient
- Assisted with basic needs
File Clerk
Dream Team of LA, Inc.
10.2013 - 11.2017
- Developing and maintaining databases
- Checking paperwork, digital forms, and files, updating or correcting documentation as needed
Education
Associate of Arts -
Hillsborough Community College
Tampa, FL05-2023
Skills
- 3M Coding
- MS Office
- Google Drive
- Strategic thinking
- Spreadsheets
- Innovative mindset
- Emails
- Deep expertise
- Time management
- Operating Systems
- Training and mentoring
- Strong analytical skills
- Customer focus
Websites
Professional Development
Healthcare Support Specialist
Certification
Healthcare Support Specialist
Languages
Spanish
Limited Working
English
Native or Bilingual
Timeline
Subject Matter Expert- Remote
Asembia
12.2023 - Current
Patient Care Coordinator- Remote
Asembia
12.2023 - Current
Prior Authorization Specialist - Remote
GoodRx
10.2022 - 12.2023
Customer Care Advocate - Remote
GoodRx
02.2021 - 12.2023
Medical Assistant
Academic Alliance of Dermatology
06.2020 - 02.2021
Medical Assistant
B3 Medical, Interventional Pain Management
11.2019 - 06.2020
Medical Assistant / X-Ray Technician
Cortez Foot & Ankle Specialists
05.2018 - 11.2019
Customer Care Representative
Hamilton Relay
11.2017 - 05.2018
Caregiver
Dream Team of LA, Inc.
10.2013 - 11.2017
File Clerk
Dream Team of LA, Inc.
10.2013 - 11.2017
Associate of Arts -
Hillsborough Community College