Cecilia Troz
San Pablo,CA
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem solving skills.
Overview
2
2
years of professional experience
Work History
Referral & Authorization Specialist
Marin Health Medical Network
Larkspur, 94934
08.2022 - Current
- Receives referral requests from providers and Health Plans representatives. Assist in processing medical services request. Completes clerical duties related to the processing of Authorization Requests and Provider Referrals.
- Verifies member’s eligibility and benefits with subsequent notification to designated staff of 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.
- Verifies fax numbers and system updates. Communicates with requesting provider for any identified need to clarify a request for an authorization, such as CPT codes, ICD10, requested timeframes and member’s demographics.
- Appropriately forwards all referral requests to the next level of clinical review as applicable and after verifying for completeness and appropriateness.
- Coordinates approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable.
- Adheres to company HIPAA policies and procedures. Identifying, maintaining and protecting sensitive HIPAA information (PHI) and following procedures to ensure the security of such information.
- Experience with, and proficiency in, electronic medical records: Use of EPIC software.
- Computer proficiency: Microsoft Office.
Education
Medical Billing & Coding
Bryman College
09-2002
Skills
- Medical terminology expertise
- Claims Management
- Insurance Verification
- HIPAA Compliance
- Effective communication skills
- Appointment Scheduling
- Data Entry
- Team building
- Professionalism
- Self Motivation
- Reliability
- Proficient with EPIC
- Team Collaboration
- Authorizations knowledge
- Proficient in Spanish
- Attention to Detail
- Task Prioritization
- Continuous Improvement
- Professional Demeanor
- Effective Communication
- Multitasking
- Ability to learn quickly, retain information, and perform with accuracy
Timeline
Referral & Authorization Specialist
Marin Health Medical Network
08.2022 - Current
Medical Billing & Coding
Bryman College