Hi, I’m
Angela Nieves
Lawrence,MA
Summary
Dependable Prior Authorization Specialist with a career spent handling various administrative responsibilities in fast-paced settings. Bilingual individual dedicated to finding solutions to issues and obtaining prior authorization information for patients. Ready to tackle new challenges.
Overview
7
years of professional experience
Work History
New England ENTNorth Andover, Massachusetts
Authorization Specialist
10.2021 - Current
Job overview
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Coordinated resolutions for issues and appealed denied authorizations.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Notified ordering providers of denied authorizations.
- Used Multi softwares to input claim, prior authorization and other important medical data into system.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
PQC - Hanscom AFBHanscom AFB , MA
General Clerk
12.2020 - 10.2021
Job overview
- Created and updated client records by entering general data, services provided and invoice information.
- Assessed customer satisfaction with services through follow-up communication.
- Safeguarded patient privacy with strict adherence to HIPAA protocols.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Maintained accurate records and documented client data in company databases.
- Built partnerships with related organizations to develop support and gain greater attention for important issues.
- Scheduled patients according to availability, urgency and insurance authorization guidelines.
- Reviewed demographic, clinical and insurance information before sending to referred specialists.
- Reviewed referral details and expectations with providers and patients and requested new referrals when necessary.
- Compiled, recorded, or coded data from referrals or surveys using computer or specified form.
- Verified documents and associated records to catch and resolve discrepancies.
- Prepared reports to provide responses to specific problems.
Fyzical Dizziness and Fall Prevention CenterLawrence, MA
Administrative Assistant - Client Care Specialist
05.2017 - 11.2020
Job overview
- Fyzical Dizziness and Fall Prevention Center (Ancillary service for New England ENT, Assisted in opening of new PT clinic including Administration set up, furniture organization and development of day to day operations
- Management of front office and supervision of PT aides, including participating in training of staff members using software and day to day operations
- Participate in the interview process for hiring Physical Therapists, PTAs, and administrative assistants
- Interpreting during PT Evaluations and treatments for providers while assisting with deliverance of care
- Assist in health fairs and community marketing initiatives
- Independent run reports regarding PT office statistics, specifically referral rate, cancellation rate, patient census, etc
- Manage PT and PTA schedules by communicating with Patients and verifying insurance benefits
- Oversee the sales of our on site store (including sales of CBD balm)
New England ENTNorth Andover, MA
Medical Secretary
06.2016 - 11.2020
Job overview
- Interpreting for ENT specialist (MD and PA's) during patient appointments to assist in the deliverance of high quality patient care
- Answering phone calls from patients, offices, and insurance companies using a multi line phone system
- Worked in the front office delivering excellent customer service, while utilizing Athena Net system for checking in/out, scheduling, requesting orders, etc.
- Managed physician calendar, scheduling patient appointments and procedures.
- Conducted patient intake interviews to collect medical information and insurance details.
- Applied knowledge of medical terminology and insurance processes to support office administration productivity.
Education
Lincoln Technical Institute - HartfordLowell Ma
Certificate from Medical Assisting
06.2012
Skills
- Strongly self motivated, reliable
- Proven ability to have strong organizational skills with capacity to handle numerous projects simultaneously
- Proficient in Athena Net and Profitware software
- HIPPA and OSHA compliance
- Precertification Requirements
- Medical Terminology
- Effective Communication Skills
- Records Maintenance
- Billing Procedures
- Recordkeeping and Data Input
- ICD 10, CPT and procedure codes knowledge
- Fluent in English and Spanish
Timeline
Authorization Specialist
New England ENT
10.2021 - Current
General Clerk
PQC - Hanscom AFB
12.2020 - 10.2021
Administrative Assistant - Client Care Specialist
Fyzical Dizziness and Fall Prevention Center
05.2017 - 11.2020
Medical Secretary
New England ENT
06.2016 - 11.2020
Lincoln Technical Institute - Hartford
Certificate from Medical Assisting