Bianca Murguia
Miami,FL
Summary
Reliable Medical Support professional with 11 years of experience in busy environment. Expertly assist with office operations and physician support by gathering patient information. Cheerful during each patient interaction to improve satisfaction ratings and patient retention.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Clinical Documentation Denial Specialist position. Ready to help team achieve company goals.
Tech-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement. Skilled in identifying opportunities for technological enhancements and implementing effective solutions. Adept at leveraging new tools and methods to solve problems and enhance productivity. Excels in adapting to fast-paced environments and driving technological advancements.
Overview
11
11
years of professional experience
Work History
Prior Authorization Specialist
Pulmonary Physician of South Florida
03.2014 - Current
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Verified eligibility and compliance with authorization requirements for service providers.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Developed and maintained productive working relationships with healthcare providers.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Interviewed applicants and explained scope of different available benefits.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Assisted clients with completion of applications and paperwork.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Communicated with people from various cultures and backgrounds on application process.
Medical Assistant
Pulmonary Physicians Of South Florida
11.2013 - Current
- Prepare patient intake as: Obtain pertinent information (i.e., Medical history)
- Taking vital signs
- Administrate vaccines
- Procedures (i.e., Alpha test)
- Assisting the physicians, ARNP and PA in the floor
- Prepare patient chart before their scheduled appointment
- Answer phone calls from patients, pharmacies and DME, etc
- Reply to medication request
- Manage Prior Authorizations/Appeals
- Enrollment for specialty Medications
- Schedule Biologic delivery
- Creating orders for Dural Medical Equipment
- Oxygen equipment
- Manage appeals for Medical necessity for coverage
- Check incoming faxes
- Assisting filling out medical forms
- Medication refill request
- Review testing results for the doctor
- Scan documents
- Request medication samples and organize it in office
- Sending out Progress Note to the PCP after every consultation
- Performed medical records management, including filing, organizing and scanning documents.
- Obtained client medical history, medication information, symptoms, and allergies.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Collected pertinent data and calculations to aid physician in interpreting results.
- Implemented care and efficiency improvements to support and enhance office operations.
- Taught patients about medications, procedures, and care plan instructions.
- Explained procedures to patients to reduce anxieties and increase patient cooperation.
- Oriented and trained new staff on proper procedures and policies.
- Liaised with patients and addressed inquiries, appointment requests and billing questions.
Education
Associate Of Applied Science - Medical Technology
01-2011
Skills
- Medical office administration
- Patient relations
- Documentation expert
- Respiratory equipment utilization
- Respiratory therapy functions
- Chronic disease management
- Medical records confidentiality
- Patient triage
- Electronic health records
- Patient flow management
- Electronic medical records
- Medical records management
- Disease prevention education
- HIPAA compliance
- Prioritizing stat orders
- Human anatomy and physiology
- Medical billing
- Clinical trial support
- Medical transcription
- Patient assessments
- Clinical documentation
- Insurance authorizations
- Conversant in English/Spanish
- Medical terminology knowledge
- Medical terminologies
- Clinical applications
- Medical terminology
- EMR / EHR
- Maintaining confidentiality
- Calm and level-headed under duress
- Billing coding knowledge
- Reliable team player
- Insurance claims
- Quick problem solver
Degree
MA
Jobtitle
Medical Assistant
Jobdescription
08/09/21, 8:30 am - 5:00 pm, Prepare patient intake, Obtain pertinent information (i.e., Medical history), Taking vital signs, Administrate vaccines, Procedures (i.e., Alpha test), Assisting the physicians, ARNP and PA in the floor, Prepare patient chart before their scheduled appointment, Answer phone calls from patients, pharmacies and DME, etc., Reply to medication request, Manage Prior Authorizations/Appeals, Enrollment for specialty Medications, Schedule Biologic delivery, Creating orders for Dural Medical Equipment, Oxygen equipment, Manage appeals for Medical necessity for coverage, Check incoming faxes, Assisting filling out medical forms, Medication refill request, Review testing results for the doctor, Scan documents, Request medication samples and organize it in office, Sending out Progress Note to the PCP after every consultation
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Prior Authorization Specialist - Pulmonary Physician of South Florida
03.2014 - Current
Medical Assistant - Pulmonary Physicians Of South Florida
11.2013 - Current
Florida Career Collage - Associate Of Applied Science, Medical Technology
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