Anita Sanabria

Respond to a variety of complex inquiries related to Optum Care services for both members, providers, health plan claims questions.

update member eligblity and verify insurance information.

Assist with authorization process and updates, status information and authorization inquiries.

Serve as a liaison between UM department and provider’s office and members.

Assist with claims status, claims denials, appeal process, timely filing, patient account fu calls, remittent and EOBs.

Adhere to IPA and medicare guidelines.

• Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.

itiate calls to veterans to educate them on their healthcare option and schedule appointments to service their healthcare needs. Reachout to healthcare professionals in the community to coordinate medical appointment and follow-up care for Veterans. Provide customer service to Veterans and providers regarding appointments , billing, missing documentation and health insurance benefits. Follow processes of VA program and perform all task in a professional manner. Comply with Hippa regulations to protect patient information. Research system to find missing information, coordinate with other Triwest departments to resolve issues. Assist provider with credentialing process to become in-network with Triwest. Meet monthly productivity metric of closing 8-10 authorization and processing a day.

Generate, process, track and store authorization and correspondence related to Care Access and Molina approvals and denials and other integrated Molina Healthcare programs including behavioral health and long term care.

Maintain relationships outside partnerships such brokers, loss payee and outside agencies.

Data entry of member demographics and hospital updates.

Process and monitor all denial letters for Medicare patients.

Demonstrate ability to multitask and meet established deadlines to assist in other departments such as prior authorization, Medicare denial letter and assist with discharge summaries for patients

Maintain daily performance goals of 250 faxes per day.