Summary
Overview
Work History
Education
Skills
Languages
Timeline
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Araceli Duran

Deming,NM

Summary

Patient-focused Medical office manager with more than 15 years of experience working in busy medical office serving diverse populations. Expert in insurance coding, billing, claims and accounts receivable. Sound skills in multiple appointment scheduling software such as Eclinical Works and Athena.

Overview

13
13
years of professional experience

Work History

Executive Administrator

Southwest Pediatric and Family Care
09.2023 - Current
  • Managed daily administrative tasks to ensure smooth operations within the medical office environment.
  • Assisted physicians with clinical documentation to ensure complete and accurate records for each patient visit.
  • Addressed and remedied all patient or team member issues.
  • Maintained up-to-date knowledge of healthcare regulations and policies, ensuring the practice remained in compliance at all times.
  • Completed bi-weekly payroll for 12 employees.
  • Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
  • Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
  • Enrolled providers and Medicaid, Medicare, and private insurance plans.
  • Conducted primary source verifications such as background checks and board certifications.
  • Received and evaluated applications to look for missing and inaccurate information.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during the credentialing process.
  • Improved turnaround time for credentialing applications by implementing an efficient online system.
  • Reduced errors in provider data management by introducing automated verification tools.
  • Pre-screened resumes prior to sending to corporate hiring managers for consideration.
  • Assessed processes and procedures, complying with OSHA, and HIPAA regulations.
  • Developed innovative marketing strategies to attract new patients while maintaining strong relationships with existing clientele.
  • Coordinated with healthcare providers to ensure seamless patient care and service delivery.

Parent Educator

Luna County PAT
08.2021 - 08.2023
  • Educated clients on parents roles with focus on skill development and guiding children through nurturing parenting.
  • Engaged families in beneficial activities targeted at improving bonds and interactions.
  • Utilized knowledge of evidence-based programs to inform parents and assist in goal-setting.

Authorization Specialist

MMC Cancer Center
02.2020 - 01.2021
  • Obtained all oral and IV chemotherapy authorizations from insurance companies
  • Documented all communication with applicants and inputted information into system using Athena.
  • Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
  • Scheduled appointments with applicants to gather information and explain benefits processes.
  • Contacted drug manufacturer for further assistance based on patient income eligibility
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Collected and processed patient liability statements prior to service.
  • Input all patient data regarding claims and prior authorizations into system accurately.

Medical Office Receptionist

Summit Healthcare And Rehabilitation
09.2015 - 02.2020
  • Coordinated patient scheduling, check-in, check-out and payments for billing.
  • Completed patient referrals to other medical specialists.
  • Responded to correspondence from insurance companies to verify patient's coverage.
  • Maintained current and accurate medical records for patients.
  • Verified insurance eligibility.
  • Obtained all medication and diagnostic studies prior authorizations.
  • Compiled and tracked outstanding balances owed to medical facilities.
  • Processed billing calls and answered questions from patients and third-party carriers.
  • Corrected, completed and processed claims for multiple payer codes.
  • Processed online and paper appeal submissions and refund requests.
  • Logged charges and payments within Eclinical Works.
  • Assisted in reconciling deposit and patient collections.
  • Handled account payments and provided information regarding outstanding balances.
  • Monitored outstanding invoices and performed collections duties.
  • Executed billing tasks and recorded information in company databases.
  • Processed payment via telephone and in person with focus on accuracy and efficiency.
  • Posted payments to accounts and maintained records.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Calculated adjustments, premiums, and refunds.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Generated financial statements and reports detailing accounts receivable status
  • Adhered to strict HIPAA guidelines to protect patient privacy.
  • Reviewed and sent medical records to other physicians upon request.
  • Aided with prescription refill requests.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Processed and recorded new policies and claims.

MRI Receptionist

Neurology Associates Of Mesilla Valley
07.2012 - 07.2014
  • Managed multi-line phone system and pleasantly greeted patients.
  • Coordinated patient scheduling, check-in, check-out and payments for billing.
  • Checked patient insurance, demographic and health history to keep information current.
  • Helped patients complete necessary medical forms and documentation.
  • Adhered to strict HIPAA guidelines to protect patient privacy.
  • Organized paperwork such as charts and reports for office and patient needs.
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Verified eligibility and compliance with authorization requirements for service providers.

Education

Associate of Arts - Health Information Technology

DACC
Las Cruces, NM
12.2020

Certification - Medical Office Management

DACC
Las Cruces, NM
12.2020

Skills

  • Data Entry Software
  • Prior Authorization Processing
  • Insurance Plan and Benefits Verification
  • Medical Billing and Coding
  • Patient Record Confidentiality
  • CPT Coding
  • Referral Tracking
  • Certified Medical Administrative Specialist
  • Patient Billing
  • Payment Scheduling and Collection
  • Claim Forms
  • Medical Records Verification
  • Prescription Refills
  • HIPPA knowledge
  • Reviewing Patient Information
  • Medical Terminology Knowledge
  • Provider Enrollment
  • Electronic Health Records Systems
  • Credentialing Requirements
  • Credentialing Policies
  • Charting and Clinical Documentation
  • Weekly Payroll
  • Medical Office Management Skills
  • Human Resources
  • Staff supervision and management

Languages

Spanish
Native or Bilingual

Timeline

Executive Administrator

Southwest Pediatric and Family Care
09.2023 - Current

Parent Educator

Luna County PAT
08.2021 - 08.2023

Authorization Specialist

MMC Cancer Center
02.2020 - 01.2021

Medical Office Receptionist

Summit Healthcare And Rehabilitation
09.2015 - 02.2020

MRI Receptionist

Neurology Associates Of Mesilla Valley
07.2012 - 07.2014

Associate of Arts - Health Information Technology

DACC

Certification - Medical Office Management

DACC

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Araceli Duran