Azalia Vicente
Garland,TX
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. Dedicated administrative professional with successful experience in fast-paced office settings. Hardworking team player with expertise in completing various clerical tasks and offering staff support. Responsible, punctual and productive professional when working with little to no supervision. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
10
10
years of professional experience
Work History
Insurance Verification Specialist
CVS Caremark Specialty Pharmacy
04.2022 - 12.2022
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
- Assisted patients with understanding personalized insurance coverage and benefits.
Benefit Verification Specialist
US Bioservices
05.2017 - 04.2022
- Managed high-volume caseloads while maintaining strict deadlines for completing benefit verifications and authorizations.
- Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy.
- Improved patient satisfaction by accurately verifying benefits and providing timely responses to inquiries.
- Provided exceptional customer service by addressing patient concerns regarding coverage and out-of-pocket expenses.
- Streamlined pre-service financial clearance processes, expediting access to care for patients in need of urgent medical intervention.
- Expedited claim approvals by promptly submitting necessary documentation to insurance providers.
- Work with clinics, hospitals to manage request for services, run adjudicated test claims for PMB and determining patient coverage/responsibility for services including, but not limited to Pharmacy Benefit Manager, Single Case Agreement, IPA's and Major Medical benefits.
- Documentation for coverage, cost share for Commerical, Medicare/Medicaid accounts.
- Troubleshoot all benefit rejection, including Prior Authorizations, cost limits and Appeals.
- Track and resolve any payer/plan, member or provider issues and report any chances, updates, or trends to management.
- Process new requests in required time frame.
- Assess patient's financial ability to afford therapy and provide hands on guidance explaining break down of cost and appropriate financial assistance if needed.
- Handle escalations and ensure proper communication of resolution within required time frame a feed upon by client/manufacture, avenues to obtain coverage for product must be fully exhausted.
- Conduct outbound correspondence when necessary to help support needs of patient and/ or program.
- Update internal treatment plan statuses and external pharmacy treatment statuses, maintain accurate and detailed notations for all interactions.
- Self-audit intake activities to ensure accurance and efficiency for program.
- Notify patients, physicians, of any financial responsibility and provide guidance, assess patient's financial ability to afford therapy and provide hands on guidance to appropriate financial assistance.
- Handle escalations based upon region and ensure proper communication of resolution within required time frame.
- Serve as liaison between client sales force and applicable party.
- Mediate situations in which parties are in disagreement and facilitate positive outcome.
- Explain benefits to plan participants in easy to understand terms in order to educate each on available options.
Prior Authorization Specialist
DaVita Rx
09.2015 - 05.2017
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
Customer Service Representative
Ambit Energy
06.2013 - 09.2015
- Handled customer inquiries and suggestions courteously and professionally.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Answered constant flow of customer calls with minimal wait times.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Updated account information to maintain customer records.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
Education
High School Diploma -
Berkner High School
Richardson, TX05.2006
Skills
- Attention to Detail
- Patient confidentiality
- HIPAA Compliance
- Insurance Coverage Verification
- Eligibility Determination
- Data entry proficiency
- Coverage and Authorizations
- Medicaid knowledge
- Healthcare Industry Knowledge
- Insurance Billing
- Medical Billing
- Electronic Medical Records
- Patient contact
Languages
Spanish
Native or Bilingual
Timeline
Insurance Verification Specialist
CVS Caremark Specialty Pharmacy
04.2022 - 12.2022
Benefit Verification Specialist
US Bioservices
05.2017 - 04.2022
Prior Authorization Specialist
DaVita Rx
09.2015 - 05.2017
Customer Service Representative
Ambit Energy
06.2013 - 09.2015
High School Diploma -
Berkner High School
Similar Profiles
Pamela AllenPamela Allen
Insurance Resolution at Contractor-CVS Caremark Specialty PharmacyInsurance Resolution at Contractor-CVS Caremark Specialty Pharmacy
Kellie L. GerowKellie L. Gerow
Data Entry Pharmacy Technician at Cvs Caremark Specialty Pharmacy through A-Line StaffingData Entry Pharmacy Technician at Cvs Caremark Specialty Pharmacy through A-Line Staffing
Marissa MaddyMarissa Maddy
Resource Planning Coordinator at CVS Caremark Specialty PharmacyResource Planning Coordinator at CVS Caremark Specialty Pharmacy