Summary
Overview
Work History
Education
Skills
Timeline
Generic

Citlali E. Roberts

National City,CA

Summary

Supportive Eligibility Specialist with extensive application engagement and dedicated service skills. Bilingual professional with skill to maintain accurate records, schedule appointments and handle various administrative responsibilities. Trained in Epic use and administration with knowledge of HMO and PPO plans. Dedicated to excellent customer service and best-in-class collaboration. Brings proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs. Efficient Authorization Specialist with comprehensive knowledge of medical insurance policies, coding and procedures. Demonstrated ability to liaise effectively between patients, healthcare providers, and insurance companies for smooth transactions. Strengths include strong problem-solving skills, thoroughness in documentation and a keen eye for identifying inconsistencies. Proven impact in previous roles includes streamlined authorization processes, improved patient satisfaction rates, and reduced claim denials.

Overview

17
17
years of professional experience

Work History

Healthcare Authorization Specialist II

Rady Children's Hospital Of San Diego
02.2020 - 02.2024
  • Educated patients on eligibility and affordability options by offering insightful information.
  • Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
  • Communicated with people from various cultures and backgrounds on application process.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Provided primary customer support to internal and external customers.
  • Trained new personnel regarding company operations, policies and services.
  • Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
  • Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology.
  • Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
  • Reduced processing times by effectively managing high volume of authorizations, referrals, and appeals.
  • Promoted positive customer experiences by addressing concerns or questions related to authorizations in a professional manner.

Patient Access Rep I

Rady Children's Hospital Of San Diego
06.2007 - 02.2020
  • Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
  • Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
  • Explained estimated cost for medical treatments and answered patient questions to promote good understanding of proposed services.
  • Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
  • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.

Education

No Degree - Dental Assisting

UEI College - San Diego
San Diego
04.2000

High School Diploma -

Mar Vista Senior High School
Imperial Beach, CA
06.1997

Skills

  • Customer Satisfaction
  • Referral Tracking
  • Medical Terminology Knowledge
  • Confidential Records Management
  • Data Entry
  • Information Assistance
  • Gathering Referrals
  • Customer Interaction
  • Benefits Guidelines
  • HIPAA Regulations
  • Insurance Verification
  • Prior Authorization Processing
  • Professionalism
  • Insurance verification

Timeline

Healthcare Authorization Specialist II

Rady Children's Hospital Of San Diego
02.2020 - 02.2024

Patient Access Rep I

Rady Children's Hospital Of San Diego
06.2007 - 02.2020

No Degree - Dental Assisting

UEI College - San Diego

High School Diploma -

Mar Vista Senior High School
Citlali E. Roberts
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