Beatriz Borja
Harmony,FL
Summary
Professional with proven track record in healthcare financial management. Adept at navigating patient financial concerns, ensuring seamless billing processes, and optimizing revenue cycles. Strong collaborator, known for adaptability and delivering results. Skilled in patient counseling, insurance verification, and financial planning. Reliable team player with focus on achieving goals and enhancing patient satisfaction.
Overview
8
8
years of professional experience
Work History
Patient Financial Navigator- Pathology
Florida Cancer Specialists
06.2024 - Current
- Responsible for performing assigned daily tasks that fall under the Managed Care department that includes but not limited to completing daily clinic A/R (Accounts Receivables) reports, calculating and reconciling daily/monthly clinic collection totals and percentages; assistance with all aspects of the Intake and Utilization Management duties; all aspects of managed care approvals; and Financial Aid.
- Managed care approvals for specialty labs making sure that diagnosis listed is payable per insurance guidelines, obtaining authorizations, financial responsibility, creating treatment estimates, calling patients to go over cost of labs and obtaining their approval for testing. Problem solving with the Doctors/APRN/PA due to insurance related issues such as appeals and peer to peers. Working with outside lab facilities for patients that do not have insurance or out of network benefits. Create and load Clinic Collections report for the Patient Services Staff to collect from patients.
- Review emails from Financial Counselors for special action drug approval request, reviewing accounts making sure criteria is met per insurance or national guidelines. Create and load AR bar reports for Patient Specialist Staff
Authorization Coordinator
Orlando Health Neuro-Spine Rehabilitation
01.2022 - 03.2024
- Request prior authorizations for evaluation and treatment for Physical Therapy, Occupational Therapy, and Speech therapy.
- Obtain authorizations for equipment being order.
- Verified ICD-9 codes and CPT billing codes to ensure payment will be processed for claim under patients insurance plan.
- Receives referral request from providers and Health Plans representative. Assist in processing medical services request. Completes clerical duties related to the processing of Authorization Request and Provider Referrals.
- Verifies
- eligibility issues.
- Inputs all requests for services received via fax or phone into the system accurately for electronically generated authorization and tracking.
- Requests submission of appropriate medical records according to established criteria for requested service(s) in accordance with the corresponding Policy and Procedure.
- Notifies required parties within the appropriate timeframe for routine and urgent request for services.
- Research member history for duplications ad consideration of authorization limits.
- Scan,attaches,reviews and effectively works with electronic images as part of the authorization process. Including recording the required information from attachments into the authorization fields.
Patient Service Represesntative
McKesson Specialty Health
09.2017 - 07.2019
- Call Center for Temple University Hospital.
- Created demographics/new medical records for new patients.
- Entered and validate insurance.
- Scheduled appointments for the following specialties: Cancer center,
- Cardiology, Dermatology, Endocrinology, Family Medicine, Gastroenterology, Head & Neck, Hematology,
- Hepatology, Infectious Disease, Internal Medicine, Nephrology, Neurology, Neurosurgery, ObGyn,
- Ophthalmology, Orthopedics, Pain Management, Pediatrics, Pulmonary, Urology, Thoracic Surgery, Bariatric Surgery, General Surgery, Vascular Surgery, Plastic & Reconstructive Surgery.
- Filed Documents and submitted escalations to the Department.
- Submitted requests for medication refills.
- Ensured we are abiding HIPPA with every call
- trained other agents
Education
No Degree - CPB AND CPC CODING
AAPC
REMOTE11-2025
Associate of Arts - English As Second Language
Goodwin College
Connecticut01-2011
Skills
- Excellent communication and customer service skills
- Fully bilingual
- Proficient in Microsoft Office tools
- Highly organized with effective time management skills
Ability to work under pressure, prioritize tasks, and complete multiple assignments efficiently
- Familiar with HIPAA guidelines and EHR software
Experience with Electronic Health Records (EHR), ONCO, Centricity software, and more - Knowledge of HMO, PPO, Medicaid, commercial insurance, and Medicare
- Experience with insurance authorizations and billing processes
- Familiar with ICD-10 and CPT codes
Timeline
Patient Financial Navigator- Pathology
Florida Cancer Specialists
06.2024 - Current
Authorization Coordinator
Orlando Health Neuro-Spine Rehabilitation
01.2022 - 03.2024
Patient Service Represesntative
McKesson Specialty Health
09.2017 - 07.2019
No Degree - CPB AND CPC CODING
AAPC
Associate of Arts - English As Second Language
Goodwin College
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