Andrea Leyba
Albuquerque,NM
Summary
Seasoned Infusion Therapy Authorization Coordinator at CHRISTUS St. Vincent, adept in enhancing authorization efficiency and compliance. Demonstrates exceptional problem-solving aptitude and professionalism, significantly improving process outcomes. Skilled in medical terminology and active listening, ensuring high-quality patient interactions and organizational growth.
Overview
22
22
years of professional experience
Work History
Infusion Therapy Authorization Coordinator
CHRISTUS St. Vincent
Santa Fe, NM
03.2024 - Current
- Implemented strategies to improve the efficiency of the authorization process.
- Monitored compliance with regulations concerning authorization processes.
- Assisted customers with questions or problems related to their authorization requests.
- Researched and compiled information for reports.
- Researched information as necessary to resolve customer inquiries or issues with authorizations.
- Reviewed and approved authorization requests according to established criteria.
- Evaluated current policies and procedures related to authorizing services or products, making changes where appropriate.
- Analyzed data from various sources to ensure accuracy of authorizations.
- Updated spreadsheets and other document filing systems.
- Processed incoming authorization requests and updated customer accounts accordingly.
- Composed letters and electronic correspondence for professionals and management team.
- Performed administrative duties such as filing, copying, scanning, faxing.
- Managed workflow processes for authorization requests, including routing documents and tracking progress.
- Provided guidance and direction on how to complete authorization forms correctly.
- Collaborated with other departments within the organization to ensure timely completion of authorizations.
- Maintained accurate records of all authorizations in the system.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Completed day-to-day duties accurately and efficiently.
Patient Care Coordinator
Christus St. Vincent
Santa Fe, NM
02.2016 - Current
- Company Overview: Orthopeadic and Sports Medicine, Patient Care Coordinator
- I am responsible for performing all tasks necessary to increase physician efficiency and improve patient experience
- I am the primary contact in my department for all patients to answer any questions whether it be clinical, administrative or financial
- I coordinate the physicians schedule, answer phones and return messages, schedule surgeries, follow up tests and referrals for patients
- I maintain a good working relationship with the physicians and co-workers
- I obtain preauthorizations for surgery, steroid injections to post-operative care and medications
- I work closely with insurance companies to pre-authorize all surgical procedures, injections, diagnostic studies
- I appeal any denied authorizations
- I Authorize all appointments for workman compensation patients for evaluation and treatment, diagnostic imaging, durable medical equipment, physical therapy, outgoing referrals, and surgery
- Keep close contact with adjusters and patients, document detailed communication in regards to patients workman comp claim
- I maintain a positive attitude at all times and I show compassion to all my patients
- When available, I assist the Medical Office staff members by covering the front desk, checking patients in and out, scheduling follow-up appointments, assist other co-workers with MRI scheduling, and assist in any way the clinic may need
- I assist patients with billing and financial information
- I do research in Epic system to figure out what the patients out of pocket expense would be and provide each provider charges for procedures
- I made sure all documentation met criteria for billing purposes
- Medicare has a very strict criteria, I would review notes to make sure we were in compliance for a smooth billing process and to make sure all procedures were medically necessary
- I provided patients with as much billing information as possible so there are no surprises after the procedure had been done
- Orthopeadic and Sports Medicine, Patient Care Coordinator
Medical Records
Professional Home Health Care
Las Vegas, NM
03.2015 - 02.2016
- Ran the Medical Records Department within the Professional Home Health Care
- Assemble health records, audit admission and discharge health records according to PHHC chart order, copy and send out documents for physician signatures, answer phones, follow proper policy and procedures for incoming and outgoing PHI, follow HIPAA policy and procedures for all health records and outgoing and incoming PHI
Caregiver
Veterans Administration
11.2013 - 02.2016
- Direct patient care
- Encourage medication compliance, encourage patient to do ADL's
- Encourage and schedule outings and social interactions
- Schedule and drive patient to appointments, attend group therapy, attend education classes
- To be a friend, to offer a helping hand, but most importantly to be a listener
- Many veterans have many behavioral health issues and don't always need to be told what to do or how it needs to be done but simply to just listen
Back up Supervisor
NMBHI at Las Vegas
Las Vegas, NM
08.2006 - 10.2013
- Supervised 12 employees within HIMD when the HIMD Director and HIMD Associate Director were not readily available due to a two year sickness on both parties
- Duties include approving and denying leave, answering questions, solving problems, training employees, monitoring work production on all employees, giving input on new departmental operational procedures and implementing new operational procedures, Kronos, time sheet submission, pay check pick up and distribution
- Date entry into Kronos time keeping software
- I was responsible for making sure all employees had their correct times, clock ins and if needed added sick/annual/medical leave
- Employees would turn in a completed document with requests for leave and I would enter it to Kronos
- I kept on top of all employees time so they would not be shorted on their paychecks
- I was responsible for supplies inventory, placing large orders for charts, office supplies and making sure we kept within budget
HIMD Back up Coder
NMBHI at Las Vegas
Las Vegas, NM
08.2006 - 10.2013
- Assisting coder in coding function at NMBHI
- Coding admission and discharge diagnosis using ICD-9CM and entering codes into the AVATAR and AS 400 computer systems
- Coding billing lab slips and physician encounter charge slips as per coding rules and regulations
- I was responsible for data entry into AS400 software system the code billing, making sure all codes were correct and in compliance with NMDOH
- I double checked all codes for medical necessity
- I made sure all documentation met criteria for billing insurance companies
Release of Information (ROI) Specialist
NMBHI at Las Vegas
Las Vegas, NM
05.2005 - 10.2013
- Ran the Release of Information (ROI) section within HIMD
- Answer phones, file, and provide new health record numbers for the admissions department
- Retrieve and check out discharged records to the admissions department, copy health records to fulfill requests to ensure NMBHI's compliance, receive requests via mail, fax, or phone and examine the requests and ensure compliance as per DOH HIPAA Policies and Procedures, receive and send out mail and faxes, complete discharge/referral packets and follow-ups, assemble health records, locate health records, stamp and log all incoming requests to assist release of information, log disclosure-recording forms as per DOH protocol, take minutes for meetings, order backlogged health records from the Record Center in Santa Fe as per NMBHI protocol, Assemble health care records for the Long Term Care Division and Adult Psychiatric Division/CARE/Forensic Division
- Retrieve active health records from the individual units and submit them to HIMD for assembly and analysis
- Audit active health records according to active Psychiatric chart order and flag appropriate documents for clinician's signature
Psychological Technician Basic
NMBHI at Las Vegas
Las Vegas, NM
01.2003 - 05.2005
- Direct patient care, filing of documents, answers phones
- Light duty-answer phones, stuffed health records with proper documents, copy health records, take health records apart for HIMD, purge health records, file documents in proper active Long Term Care chart order and order supplies
Customer Service Representative
The Connection
Las Vegas, NM
10.2002 - 01.2003
- Answer phones, troubleshoot cricket cell phones, help customers, activate phones, and type memos on every account
- I assisted customers with billing, taking payments and explaining bills
Education
Luna Community College
Las Vegas, NM01.2011
New Mexico Highlands University
Las Vegas, NM10.2001
High School Diploma -
Mora High School
Mora, NM05.2000
Skills
- Organizational growth
- Effective time management
- Critical thinking
- Prior authorization
- Medical terminology proficiency
- Professionalism and ethics
- Communication Etiquette
- Active listening
- Reliability
- Multitasking capacity
- Time management abilities
- Process improvement
- Organizational ability
- Problem-solving aptitude
- Problem-solving abilities
Awards
2005, HIMD Employee of the Year
Computer Experience
- Microsoft Word
- AS400
- AVATAR
- E-Copy
- Microsoft Excel
- Microsoft Outlook
- Microsoft PowerPoint
- Internet
- Patron
- ECW
- Athena
- Cerner
- Power chart
- Healthxnet
- API
- E-med
- NM PMP Aware
- Vitalware
- IKnowmed
- Mosaiq
- Epic
- Medecision
Affiliations
Committed to helping others through volunteer work while fostering strong morals and values in my family
Accomplishments
- Achieved Employee of the Year status just months into the role
- Catching Up a Backlog - Streamlined workflow to enhance productivity and minimize backlog issues
- Acknowledged for exceptional effort and commitment
Languages
Spanish
Native/ Bilingual
References
References available upon request.
Timeline
Infusion Therapy Authorization Coordinator
CHRISTUS St. Vincent
03.2024 - Current
Patient Care Coordinator
Christus St. Vincent
02.2016 - Current
Medical Records
Professional Home Health Care
03.2015 - 02.2016
Caregiver
Veterans Administration
11.2013 - 02.2016
Back up Supervisor
NMBHI at Las Vegas
08.2006 - 10.2013
HIMD Back up Coder
NMBHI at Las Vegas
08.2006 - 10.2013
Release of Information (ROI) Specialist
NMBHI at Las Vegas
05.2005 - 10.2013
Psychological Technician Basic
NMBHI at Las Vegas
01.2003 - 05.2005
Customer Service Representative
The Connection
10.2002 - 01.2003
Luna Community College
New Mexico Highlands University
High School Diploma -
Mora High School
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