Anne Huertas
Zephyrhills,FL
Summary
Hardworking Authorization Representative with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 10 years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
10
10
years of professional experience
Work History
Authorization Representative
AdventHealth Medical Group
07.2024 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Maintained compliance with patient privacy and security regulations.
- Authorized surgical requests in accordance with applicable plan guidelines.
- Collaborated with specialty offices to process patients lacking coverage for planned procedures.
- Escalated requests for non-standard services to insurances.
- Maintained patient confidentiality and safeguarded medical records to avoid information breaches.
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Member Care Advocate
Suncoast Credit Union
06.2022 - 02.2024
- Improved patient satisfaction with tailored support and resources based on individual needs.
- Promoted a supportive and inclusive environment among care team members, fostering collaboration and mutual respect.
- Participated in ongoing professional development opportunities to stay current on industry best practices and trends in patient advocacy.
- Established strong partnerships with community organizations for resource referral purposes, expanding the range of available assistance options for patients in need.
Patient Experience Specialist
AdventHealth
01.2022 - 06.2022
- Enhanced patient satisfaction by providing personalized care and addressing individual needs.
- Improved patient experience scores through effective communication and empathy.
- Verified patient insurance eligibility and entered patient information into system.
- Answered incoming calls, scheduled appointments and filed medical records.
Access Scheduler
Children's Hospital of Philadelphia, CHOP
07.2019 - 11.2021
- Utilized scheduling software to its full potential, enabling more accurate and efficient planning.
- Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
Scheduling Secretary
Grand View Hospital
07.2016 - 07.2019
- Resolved scheduling conflicts to maintain high-quality patient services.
- Improved surgery room utilization with meticulous scheduling, avoiding overlaps and downtime.
- Collaborated closely with administrative staff to ensure adequate staffing levels during high-volume surgery days or absences among team members.
- Reduced scheduling errors significantly, meticulously verifying details with surgeons and anesthesiologists.
- Maintained accurate records for billing purposes, ensuring proper reimbursement from insurance carriers and patients alike.
- Handled urgent requests effectively, prioritizing cases requiring immediate attention while also balancing routine surgery demands appropriately.
- Enhanced team collaboration by regularly updating all relevant parties on schedule changes or adjustments.
- Organized all necessary documentation for successful completion of medical audits related to surgery scheduling practices.
- Assisted with medical coding and billing tasks.
Patient Services Coordinator
St Christopher Children's Hospital
02.2015 - 07.2016
- Managed sensitive patient data with strict adherence to HIPAA regulations, ensuring privacy and confidentiality at all times.
- Contacted insurance company to verify patient coverage before visit.
- Collaborated with colleagues to maintain and upkeep office and waiting area to provide clean and organized environment for patients.
- Called patient to confirm appointment and prepared paperwork prior to visit to expedite check-in process.
- Maintained accurate patient records by diligently updating information in the electronic health record system.
- Collected time of service payments and issued receipts.
- Supported billing department efforts by accurately collecting co-payments, verifying insurance coverage, and addressing financial concerns for patients.
- Telephoned and interviewed patients and family members to obtain pre-registration information and confirm appointments.
- Demonstrated exceptional customer service to foster welcoming and professional environment for patients.
- Provided patient with after-visit summary and scheduled next appointment to maintain continuous care and facilitate treatment plan.
- Verified patient's insurance eligibility and benefits coverage.
- Greeted and assisted patients with check-in procedures.
Education
Associate of Applied Science - Patient Services Representative
Community College of Philadelphia
Philadelphia, PA06-2016
Certificate of Technical Studies - Medical Coding & Billing
Lincoln Technical Institute
Philadelphia, PA06-2007
Skills
- Patient insurance verification
- Knowledge of clinical terminology
- Health Insurance Plan Knowledge
- Data quality assurance
- Effective communication in call center environments
- Precertification management
- Confidential Records Management
- Document Scanning
- Data entry proficiency
- Medical coding
- Insurance authorization
Timeline
Authorization Representative
AdventHealth Medical Group
07.2024 - Current
Member Care Advocate
Suncoast Credit Union
06.2022 - 02.2024
Patient Experience Specialist
AdventHealth
01.2022 - 06.2022
Access Scheduler
Children's Hospital of Philadelphia, CHOP
07.2019 - 11.2021
Scheduling Secretary
Grand View Hospital
07.2016 - 07.2019
Patient Services Coordinator
St Christopher Children's Hospital
02.2015 - 07.2016
Associate of Applied Science - Patient Services Representative
Community College of Philadelphia
Certificate of Technical Studies - Medical Coding & Billing
Lincoln Technical Institute
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