Andrea Villafuerte
Sacramento,CA
Summary
Healthcare operations and administrative professional with 20 years of experience supporting high-volume clinical, correctional, and government healthcare environments. Proven expertise in patient access, medical records management, compliance (HIPAA, state/federal regulations), and cross-functional coordination. Recognized for reliability, attention to detail, and ability to maintain accuracy and service excellence in fast-paced, high-pressure settings.
Overview
20
20
years of professional experience
Work History
Patient Service Representative III
UC Davis Health – Comprehensive Cancer Center, Radiation Oncology
Sacramento, CA
01.2025 - Current
- Provide advanced patient access and administrative support within a specialized oncology service line.
- Independently manage complex scheduling for radiation oncology treatments, follow-up visits, and multidisciplinary care coordination.
- Serve as a key liaison between patients, providers, radiation therapists, nursing staff, and external referring offices.
- Ensure accuracy and completeness of referrals, prior authorizations, and insurance documentation to prevent delays in cancer treatment.
- Address escalated patient concerns with empathy and discretion, supporting patient-centered care in a high-acuity environment.
- Maintain strict compliance with HIPAA, oncology-specific documentation standards, and institutional policies.
- Support process improvements and workflow efficiencies to enhance patient experience and clinic operations.
Patient Service Representative II
UC Davis Health – Spine Clinic Orthopedic/Neurosurgery/PM&R
Sacramento, CA
07.2023 - 01.2025
- Served as a primary point of contact for patients, providers, and internal staff in a high-volume radiation oncology clinic.
- Managed multi-line phone systems, triaging calls and messages to appropriate clinical and administrative personnel while meeting service standards.
- Processed incoming new patient referrals, ensuring accurate demographic entry, insurance verification, and attachment of authorizations to support timely scheduling.
- Coordinated appointments and required documentation with referring providers, specialists, and patients to ensure continuity of oncology care.
- Accurately registered patients and maintained demographic and insurance information within electronic health record (EHR) systems.
- Collaborated closely with physicians, nurses, and radiation therapy staff to support clinic workflows.
- Responded to patient inquiries regarding scheduling, insurance coverage, referrals, and clinic policies.
- Handled sensitive patient concerns and protected health information with professionalism and strict adherence to HIPAA guidelines.
Records Officer I
Sacramento County Sheriff’s Department
Sacramento, CA
05.2022 - 09.2022
- Ensured compliance with applicable laws, Department of Justice standards, and Bureau of Prisons policies.
- Coordinated daily schedules for 150+ inmates, including medical appointments, work assignments, and visitation.
- Monitored facility safety through security audits, CCTV systems, intercoms, and controlled-access doors.
- Reviewed warrants and legal documents for accuracy, completeness, and proper record updates.
- Maintained security and safety of staff and inmates through consistent application of procedures and sound judgment.
Advanced Medical Support Assistant
U.S. Department of Veterans Affairs
Mather, CA
10.2021 - 04.2022
- Served as primary front-office contact for patient check-in and check-out in a federal healthcare setting.
- Maintained accurate patient profiles, demographics, and appointment records to ensure continuity of care.
- Managed clinic cancellations and schedule adjustments with minimal supervision.
- Utilized healthcare information systems to prioritize tasks and meet clinical and patient needs.
Medical Records Technician (Lead)
Adult Correctional Health, County of Sacramento
Sacramento, CA
10.2017 - 09.2021
- Led and coordinated workflow for a team of five medical records staff.
- Maintained and audited paper and electronic medical records in compliance with federal and state regulations.
- Retrieved and released confidential medical and psychiatric records for law enforcement, courts, and authorized entities.
- Reviewed subpoenas, court orders, and regulatory requests to ensure timely and compliant responses.
- Enforced strict release-of-information and confidentiality protocols.
- Resolved conflicts and facilitated effective communication among internal and external stakeholders.
Bill Review Analyst
CorVel Corporation
Folsom, CA
06.2015 - 09.2017
- Conducted quality reviews of medical bills for accuracy, completeness, and duplicate charges.
- Re-priced hospital bills in accordance with California Workers’ Compensation fee schedules.
- Applied ICD-9 and ICD-10 coding standards to ensure compliant claims processing.
- Performed appeal re-evaluations and routed cases appropriately for further analysis.
Senior Administrator – Appeals
Maximus Federal Services
Folsom, CA
07.2014 - 09.2014
- Coordinated independent medical review requests related to medical necessity determinations.
- Reviewed and validated case documentation for accuracy, logic, and completeness.
- Determined case eligibility and facilitated clinical reviewer matching.
- Prepared and issued final determination letters in accordance with regulatory guidelines.
- Acted as liaison among injured workers, providers, medical professionals, and state agencies.
Patient Biller
Sacramento Heart & Cardiovascular
Sacramento, CA
09.2012 - 07.2014
- Verified insurance coverage and benefits using Centricity prior to outpatient services.
- Managed coordination of benefits for primary, secondary, and tertiary insurance plans.
- Processed new patient referrals and obtained prior authorizations for diagnostic imaging.
- Supported billing accuracy for cardiovascular specialty services.
Claims Representative III / Team Lead
EDS / Hewlett-Packard
Rancho Cordova, CA
01.2006 - 10.2011
- Handled high-volume inbound calls related to hospital, dental, pharmacy, and physician claims.
- Verified eligibility and coordination of benefits for Medicaid and Medicare members.
- Researched and resolved claim denials, payment discrepancies, and EOB rejections.
- Documented all interactions in CRM systems in compliance with HIPAA standards.
- Assisted customers with electronic transaction services and online claim submission tools.
Education
High School Diploma -
Hogan High School
Vallejo, CASkills
- Patient Access & Scheduling
- Healthcare Administration
- Medical Records Management
- HIPAA & Regulatory Compliance
- Referrals & Prior Authorizations
- Documentation, Auditing & Reporting
- Interdepartmental & Provider Communication
- Team Leadership & Workflow Coordination
- Customer Service in Clinical Settings
- Microsoft Office (Word, Excel, Outlook)
Timeline
Patient Service Representative III
UC Davis Health – Comprehensive Cancer Center, Radiation Oncology
01.2025 - Current
Patient Service Representative II
UC Davis Health – Spine Clinic Orthopedic/Neurosurgery/PM&R
07.2023 - 01.2025
Records Officer I
Sacramento County Sheriff’s Department
05.2022 - 09.2022
Advanced Medical Support Assistant
U.S. Department of Veterans Affairs
10.2021 - 04.2022
Medical Records Technician (Lead)
Adult Correctional Health, County of Sacramento
10.2017 - 09.2021
Bill Review Analyst
CorVel Corporation
06.2015 - 09.2017
Senior Administrator – Appeals
Maximus Federal Services
07.2014 - 09.2014
Patient Biller
Sacramento Heart & Cardiovascular
09.2012 - 07.2014
Claims Representative III / Team Lead
EDS / Hewlett-Packard
01.2006 - 10.2011
High School Diploma -
Hogan High School