Summary
Overview
Work History
Education
Skills
Timeline
Generic

Carmen Menjivar

Rochester,NH

Summary

Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows. Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 10 years of managing documentation. Considered team player with exemplary multitasking skills.

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Overview

19
19
years of professional experience

Work History

Prior Authorization Specialist

Atlantic Digestive Specialist
09.2023 - 03.2024
  • Streamlined prior authorization processes by implementing efficient tracking systems.
  • Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
  • Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
  • Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
  • 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.
  • Assisted in the development of departmental guidelines and procedures for prior authorization processes, improving overall efficiency.
  • Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.

Imaging Support Specialist

Wentworth Douglas Hospital
08.2018 - 07.2023
  • Improved image quality by implementing advanced imaging techniques and protocols.
  • Streamlined workflow for increased productivity by optimizing imaging equipment settings and calibration.
  • Enhanced patient comfort during procedures, ensuring clear communication and providing support throughout the process.
  • Maintained accurate records of all imaging results, contributing to comprehensive patient care.
  • Collaborated with radiologists and other medical professionals to interpret images and diagnose conditions accurately.
  • Reduced wait times for patients by efficiently scheduling appointments and managing daily workloads.
  • Assisted in the development of departmental policies and procedures, promoting a culture of safety and compliance with industry standards.
  • Optimized resource utilization by maintaining inventory levels of supplies and equipment, minimizing downtime due to shortages or malfunctions.
  • Strengthened relationships with referring physicians through timely communication of results and consultation on complex cases.
  • Provided training and mentorship to new staff members, fostering a collaborative team environment.
  • Increased efficiency within the department by identifying areas for improvement in workflow processes or equipment usage patterns.

Administrative Assistant to Directors of Finance

Partners Healthcare Corporates
04.2014 - 06.2018
  • Enhanced office efficiency by streamlining administrative processes and implementing organizational systems.
  • Supported executive staff through scheduling meetings, coordinating travel arrangements, and preparing crucial documents.
  • Boosted team productivity by managing communication channels and ensuring timely responses to inquiries.
  • Ensured accurate record-keeping with diligent data entry and database management for vital company information.
  • Facilitated collaboration within the team by organizing regular meetings, maintaining meeting minutes, and tracking project progress.
  • Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
  • Assisted in onboarding new employees, providing training materials, and coordinating orientation schedules to ensure a smooth integration into the team.
  • Managed expense reports for executive staff members, ensuring accurate documentation of spending for budgeting purposes.
  • Optimized calendar management for executives by scheduling appointments strategically while considering priorities and minimizing conflicts.
  • Promoted a positive work environment through effective communication skills and fostering professional relationships among colleagues.
  • Coordinated office supply inventory management, proactively ordering necessary items before depletion to avoid workflow disruptions.

Practice Coordinator II

Newton Wellesley Hospital
10.2004 - 04.2014
  • Enhanced patient experience by streamlining appointment scheduling and follow-up procedures.
  • Reduced wait times for patients by efficiently managing daily clinic operations.
  • Improved staff communication and collaboration with the implementation of a centralized information system.
  • Increased patient satisfaction by addressing concerns promptly and professionally.
  • Coordinated staff training sessions to improve customer service skills and increase job satisfaction.
  • Maintained a clean, organized, and welcoming office environment for patients and staff members alike.
  • Oversaw billing processes, ensuring timely submission of claims and prompt payment from insurance providers.
  • Collaborated with physicians to develop policies and procedures that improved overall practice efficiency.
  • Ensured compliance with HIPAA regulations by implementing strict privacy policies throughout the practice.
  • Managed the recruitment, hiring, and onboarding process for new team members to maintain optimal staffing levels at all times.
  • Implemented new electronic medical record system, resulting in more accurate documentation of patient care.
  • Streamlined inventory management processes to reduce waste and ensure availability of necessary supplies at all times.
  • Established partnerships with local healthcare providers to offer comprehensive services for patients within the community.
  • Developed marketing strategies to attract new patients, increasing overall clientele base over time.
  • Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions.

Education

High School Diploma -

Choice Thru Education
Chelsea Ma
06.2005

Skills

  • Medical Coding
  • Insurance Verification
  • Insurance procedures
  • Workflow Management
  • Benefit Coverage
  • Retro-Authorizations
  • Medicare and Medicaid knowledge
  • Medical terminology knowledge
  • Understanding of insurance details
  • Billing Procedures
  • Authorizations
  • Data Entry
  • Effective communication skills
  • Medical Terminology
  • Physician order verification
  • Patient Scheduling
  • Provider Relations
  • Critical thinking abilities
  • Records Maintenance
  • Patient Referrals
  • Claim research
  • Understanding of medical terms
  • ICD-10 Coding Familiarity
  • Claims processing experience
  • Prior Authorization Process
  • Medical Office Procedures

Timeline

Prior Authorization Specialist

Atlantic Digestive Specialist
09.2023 - 03.2024

Imaging Support Specialist

Wentworth Douglas Hospital
08.2018 - 07.2023

Administrative Assistant to Directors of Finance

Partners Healthcare Corporates
04.2014 - 06.2018

Practice Coordinator II

Newton Wellesley Hospital
10.2004 - 04.2014

High School Diploma -

Choice Thru Education

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Carmen Menjivar