Summary
Overview
Work History
Skills
Additional Information
Languages
Timeline
Generic

Cherrie Alhambra

Morton Grove,IL

Summary

To the best of my ability, I strive to be a pragmatic insurance verification and authorization specialist touting over 10 years of expertise in benefits explanation, coverage tracking, prior, and retroactive authorization. Humbly, I state that I am a hardworking and passionate team player with vast knowledge of medical terms and working with all types of personalities effectively. I have been commended and applauded to have excellent organizational skills, is dependable and have had successes at managing multiple priorities with a positive attitude. Moreover, I take on added responsibilities to meet team goals and be of substantial help to our patients.

Overview

23
23
years of professional experience

Work History

Insurance Verification and Authorization Rep

NMUA/UROPARTNERS/SOLARIS
07.2003 - Current
  • Updated patient records with accurate, current insurance policy information.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Complied with HIPAA guidelines and regulations for confidential patient data.
  • Achieved insurance pre-authorizations to enable timely patient procedures.
  • Trained new staff on current, correct insurance verification procedures.
  • Assisted patients with understanding personalized insurance coverage and benefits.
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
  • Communicated verification and authorization status updates with different insurance departments, 3rd party prior authorization companies, insurance verification and billing department for various facilities to facilitate decision-making for patient admissions and insurance coverage.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
  • Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
  • Managed office logistics by scheduling appointments, maintaining files and collecting payments.
  • Performed various administrative tasks by filing, copying and faxing documents.
  • Answered phone calls and messages for four urologists, scheduling appointments, and handling patient inquiries.
  • Prepared and processed patient referrals and transfer requests.
  • Organized and maintained patient chart filing system to promote quick data finding for staff.

Patient Representative

Evanston Urology
05.2000 - 06.2003
  • Verified any changes or data updates to patient records and checked insurance information at each appointment.
  • Observed all facility rules and regulations regarding patient data to promote confidentiality and integrity.
  • Informed patients of excessive wait times and offered to reschedule appointments.
  • Monitored patient flow throughout day to maintain appointment times and schedules.
  • Scheduled appointments for patients and placed reminder calls 48 hours before office visits
  • Maintained clean and safe environment to promote patient safety and comfort.
  • Answered patient assistance calls, assessed needs, and offered qualified support.
  • Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.

Skills

  • Customer Experience
  • Referral Coordination
  • Organization and Time Management
  • Insurance Plan Verification
  • Prior Authorization Processing
  • Insurance Terminology
  • Benefits Verifications
  • Electronic Health Records Systems
  • Diagnostic Codes
  • Teamwork and Collaboration
  • Patient Eligibility Requirements
  • Referral Tracking
  • Insurance Authorizations
  • Data Verification
  • Data Integrity
  • Adaptable and Flexible

Additional Information

I am very familiar with both the Advocate and Ascension EPIC system and have access to most insurance websites. On an as needed basis, I have processed referrals for office procedures, tests, and surgery. Since I work for a specialist, I am able to decipher different types of insurances and IPA status since we get referrals from various PCPs besides Advocate Medical Group. With the ever changing insurances, I created what we call an "Insurance Book" which is a grid that consists and is divided among the following: Insurance Name, Important comment or note, Participating Laboratory, Referral and or Prior auth information for office procedures, and RQI. I update our insurance book as needed and as we get updates from our corporate credential representative. In addition to the English language, I am fluent in Tagalog. I can comprehend and communicate in Spanish though not as well as in English and Tagalog. In closing, as the only insurance representative/coordinator for our practice, I train and is the reference person with questions, issues, or concern with all and any facets of insurance.

Languages

English
Native or Bilingual
Spanish
Limited Working

Timeline

Insurance Verification and Authorization Rep

NMUA/UROPARTNERS/SOLARIS
07.2003 - Current

Patient Representative

Evanston Urology
05.2000 - 06.2003

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Cherrie Alhambra