Beatriz A. Urbina-Zuniga
Fort Worth,TX
Summary
Bilingual, enthusiastic and eager to contribute to team success through hard work, attention to detail, and excellent organizational skills.
Professional in the insurance industry with extensive expertise in authorization processes and patient care. Proven track record in navigating complex authorization procedures and ensuring timely approvals. Focused on collaborative teamwork and achieving results, adaptable to changing needs. Reliable in utilizing critical skills such as data accuracy and effective communication to support healthcare operations.
Overview
21
21
years of professional experience
Work History
Med Biller
Pharmerica Professional Services LLC.
REMOTE
02.2024 - 04.2026
- Responsibilities included:
- Initiated Medication prior authorizations for long term facilities.
- Followed up with insurance repairs on statuses.
- Insurance verification.
- Answer inbound and outbound calls accordingly.
- Evaluated prior authorization requests for pharmaceutical services to ensure compliance with organizational policies.
- Processed and tracked prior authorization submissions using electronic health record systems.
Insurance Authorization Specialist
Accentcare
REMOTE
08.2021 - 12.2023
- Responsibilities included:
- Responsible for day-to-day process of working predetermination workflow.
- Responsible for keeping up with initial and ongoing authorization requests following set guidelines and accurate entry of related information in HCHB (Homecare Homebase).
- Responsible for filling in to help verification team to verify patient eligibility and benefit details.
- Handle incoming calls from patients, insurance companies and other departments.
Insurance Specialist-Central Access Services Department
Huron Consulting
REMOTE
05.2021 - 07.2021
- Responsibilities included:
- Worked workque assigned to me for the day and verify and update all patient insurances.
- Verify patient’ policy for procedures and /or surgeries.
- Obtain Authorizations and referrals when needed and gathering necessary clinical documentation to insurance to support medical necessity or if a non-par provider reach out to the provider requesting procedure/surgery.
- Maintained a comprehensive understanding of deductible,-Co-insurance, out of pocket and copayment in order to complete point of service to assure a smooth check in work flow.
- Making outbound calls to insurance carriers or utilizing online tools.
- Follow ups on pending referrals and authorizations.
- Submitted notification for urgent hospital admissions for overnight and/or same day admissions.
- Contact third party payers to confirm billing party address (Workers Compensation patients).
- Resolve any issues with coverage and escalate complicated issues to supervisor or manager.
- Review all manage are updates to stay current on insurance plan changes or requirements.
Insurance Specialist-Central Access Services Department
Baylor Scott & White Hospitals
REMOTE
12.2015 - 05.2021
- Responsibilities included:
- Worked workque assigned to me for the day and verify and update all patient insurances.
- Verify patient’s policy for procedures and /or surgeries.
- Obtain Authorizations and referrals when needed and gathering necessary clinical documentation to insurance to support medical necessity or if a non-par provider reach out to the provider requesting procedure/surgery.
- Maintained a comprehensive understanding of deductible,-Co-insurance, out of pocket and copayment in order to complete point of service to assure a smooth check in work flow.
- Making outbound calls to insurance carriers or utilizing online tools.
- Follow ups on pending referrals and authorizations.
- Submitted notification for urgent hospital admissions for overnight and/or same day admissions.
- Contact third party payers to confirm billing party address (Workers Compensation patients).
- Resolve any issues with coverage and escalate complicated issues to supervisor or manager.
- Review all manage are updates to stay current on insurance plan changes or requirements.
Phone Operator/Front Office Personnel/Medical Assistant
Solace Counseling
Dallas, Texas
05.2013 - 12.2014
- Responsibilities included:
- Provided excellent customer service in a medical institution and ensured all patients were well attended.
- Managed office operations, work flow, performance management and training/development of specialty practice.
- Provided support and performed regular QA reviews for client intake, registration and scheduling functions.
- Managed client reception and client services coordination.
- Maintained health records.
Office Medical Administrative/Medical Assistant
Vladislav L. Yeganov, M.D.
Dallas, Texas
08.2009 - 05.2013
- Responsibilities included:
- Provided excellent customer service in a medical institution and ensured all patients were well attended.
- Managed office operations, work flow, performance management and training/development of specialty practice.
- Provided support and performed regular QA reviews for client intake, registration and scheduling functions.
- Managed client reception and client services coordination.
- Maintained health records and billing system.
- Managed facility procedures related to insurance and billing and solved patients’ queries regarding their insurance renewal and expiry.
- Provided the required leadership, support and direction for office initiatives and special projects.
- Monitored the equipment used in the office and facilitated repair or replacement as per requirement.
- Facilitated the management in completing general formalities related to the patients such as insurance and medical reports.
Medical Assistant
The Liver Institute
Dallas, Texas
09.2008 - 07.2009
- Responsibilities included:
- Fulfilled the role of and Medical Assistant.
- A patient Advocate; assess patient status and notify physician of any clinical changes.
- Scheduled, coordinated and delivered patient care for patients.
- Assist patients finding financial help for medical expenses.
- Travel to satellite clinic.
Front Office Coordinator/Medical Assistant
The Stockton Roberts Clinic
Dallas, Texas
05.2006 - 09.2008
- Responsibilities included:
- Fulfilled the role of front office coordinator and Medical Assistant with the responsibility of making sure the clinic was in place.
- Act as a patient advocate; assess patient status and notify physician of any clinical changes
- Complete patient billing; managed any patients billing problems and resolved the issue.
- Scheduled, coordinated and delivered patient care for geriatric to HIV patients.
- Notify patients of any responsibility the insurance payer will not cover such as co-pays, deductibles and/or co-insurances.
Medical Assistant
Dallas Heart Care
Dallas, Texas
05.2005 - 04.2006
- Responsibilities included:
- Fulfilled the role of Medical Assistant with the responsibility of triaging patients and assisting the doctor in the rooms.
- Scheduled and coordinated hospital procedures for patients and made sure the procedure was authorized through patients insurance.
- Assist the physician with stress test and stress echoes.
- Coordinate patient s pre-op appointments interact with applicable departments or clinics in regards to patients care.
Education
Billing/Coding & Medical Management and Technology
DeVry University
01-2022
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PCI Health Training Center
01-2005
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Skyline Career Development Center
01-2004
Skills
- Proficient in 10 years of Microsoft word, excel, power point and outlook
- Epic software
- Typing speed: 50 WPM
- Billing
- Data entry proficiency
- HIPAA compliance
- Insurance coverage verification
- Eligibility determination
- Communication and interpersonal skills
Timeline
Med Biller
Pharmerica Professional Services LLC.
02.2024 - 04.2026
Insurance Authorization Specialist
Accentcare
08.2021 - 12.2023
Insurance Specialist-Central Access Services Department
Huron Consulting
05.2021 - 07.2021
Insurance Specialist-Central Access Services Department
Baylor Scott & White Hospitals
12.2015 - 05.2021
Phone Operator/Front Office Personnel/Medical Assistant
Solace Counseling
05.2013 - 12.2014
Office Medical Administrative/Medical Assistant
Vladislav L. Yeganov, M.D.
08.2009 - 05.2013
Medical Assistant
The Liver Institute
09.2008 - 07.2009
Front Office Coordinator/Medical Assistant
The Stockton Roberts Clinic
05.2006 - 09.2008
Medical Assistant
Dallas Heart Care
05.2005 - 04.2006
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PCI Health Training Center
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Skyline Career Development Center
Billing/Coding & Medical Management and Technology
DeVry University