Luciana Warren

• Responsible for timely processing of GI medication authorizations, infusion authorizations, surgical procedures and pre-determinations for all managed care and other carriers as required for all elective surgeries scheduled on all patients, Complex Radiology procedures scheduled at non-USF Radiology Centers and Authorization Work queue in EPIC
• Coordinates getting relevant CPT and ICD -10 codes from Surgical Abstractor that codes for each physician
• Obtains relevant information from patient's Medical USF Medical Record as well as Hospital Medical Records that are needed to initiate pre-determination or authorization request
• Verifies insurance coverage and obtains information regarding medications, infusion authorizations and surgical medical benefits including deductible and out-of-pocket expense
• Coordinates follow-up phone call on initial requests until pre-certification or authorization is received
• If peer-to-peer is requested, gathers name and phone number information on who physician needs to call and e-mails this information to physician and administrative support staff upon receipt
• Puts detailed notes regarding infusion/surgeries in general comments on patient's USF medical record's demographic screen that includes infusion, medication and surgical benefits including deductible and out-of-pocket expense, date of surgical procedure, patient status, Surgeon's name, CPT and ICD-10 codes, insurance contact name, phone number and extension and actual Authorization Number
• Communicates with patients, Physicians, Administrative Support Staff and Hospital personnel regarding pending requests until any issues are resolved and authorization or pre-certification is obtained.
• Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.
• Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.
• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
• Collected and processed patient liability statements prior to service.

Worked as a liaison with Advent Health Medical Group and Advent Health Hospitals both Tampa and Carrollwood

• Obtained insurance verification's, notifications, per-certifications and authorizations in a timely manner for all patients
• This includes clinic visits, in office infusions, outpatient hospital infusions, radiology/laboratory testing, surgical procedures, endoscopic/colonoscopy procedures, STAT same day procedures and medication authorizations
• Worked in a fast-paced environment closely with multiple Physicians, Nurse Practitioners, Physician Assistants and Medical Assistants to ensure prompt treatment for patients
• Identified any problems and communicated with Revenue Cycle team, Coders, Patient Account Reps, Supervisors and Insurance companies in a timely manner
• Routinely arranged peer to peer authorization calls between specialist and insurance companies Medical Director
• Prepares appeal letters for any denials received
• Assist with correcting claim denials
• Provides help to patients in understanding their financial responsibilities.
• Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.
• Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.

Followed specific and established procedures regarding input of billing information into the practice management system, which included the pre-processing, coding and organizing data into batches, Follow up with re-bills, denials, transfers and purged accounts

• Notifying the Manager of Billing and Collections of issues arising
• Obtain authorizations and referrals as needed for offices.
• Built a loyal following through engaging author-reader interactions at book signings, speaking engagements or online platforms.
• Developed captivating storylines and characters, resulting in increased book sales and positive reader feedback.
• Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.
• Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.

• Responded to telephone and online authorization of routine Home Health Services
• Verified insurance coverage and benefits with insurance companies to gather policy benefits/limitations (pre-authorization requirement, documentation required to process claims, etc.)
• Coordinated authorizations for the services associated with Home Health Care patients
• Acted as liaison between the agency and insurance companies
• Knew the latest Managed Care and Medicare Contract guidelines
• Obtained authorizations for patients Skilled Nursing, Physical Therapy, Occupational Therapy, Hospice and SNF to include initial, recertification and any additional authorizations needed.
• Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.
• Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.

• Responsible for accurate and timely insurance verifications and authorizations
• Monitored the workflow of the daily duties for the CIS department
• Monitored the timeliness of all initial and subsequent authorizations for the company
• Ran and reviewed all insurance tool reports
• Contacted insurance companies gathered insurance information
• Entered and monitored all insurance information for both Florida and Louisiana branches.
• Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.
• Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.

• Contacted insurance companies to gather policy benefits/limitations (e.g., deductible amount, copayment, effective date, pre-authorization requirement, visit limitations, documentation required to process authorizations
• Coordinates multiple billings for clients with multiple providers
• Contacts branch staff, insurance carriers, Credit/Collections staff to resolve insurance related problems monitored changes in insurance related procedures.
• Collaborated with multidisciplinary teams to ensure timely submission of documentation required for insurance approval.
• Improved patient care by efficiently coordinating authorizations for medical procedures and treatment plans.