Claudia Palacio
Miami,FL
Summary
Resourceful Specialist offering expertise in problem-solving, clinical data analysis and customer service. 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 5 years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Outpatient Specialist & Community Health Services
Jackson Behavioral Health Hospital
Miami, FL
09.2019 - Current
- Verify insurance information for new patients as well as update insurance information for existing patients. Review chart documentation to ensure patient meets medical policy guidelines necessary to receive the services requested. Maintain clinical accuracy of prior authorizations with appropriate prescriber; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed. Communicate with prescribers for clarification or additional information required to complete clinical content of prior authorizations. Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations. Ensure all prior authorization for outpatient services including Case Management, Behavioral Health Therapy, and Psychological Testing are approved by the insurance before the patient continuous services.
Referral Coordinator
Miami Urgent Care
Miami, FL
03.2019 - 09.2019
- Receive and direct phone calls, schedule appointments,
check-in and check-out patients, obtain necessary patient
information to file and update patient records, and ensure
all forms and consents are completed by patients.
Obtaining patient authorization for medical records release
(HIPAA compliance). Schedules follow up appointments
after the completion of each visit. Take the necessary
payment depending of the service provided to the patients.
Reconciles cash against daily charge and run cash reports.
As a referral coordinator, I am able to obtain authorizations
for patient referrals to specialists, diagnostic testing and
procedures. Advise physician if authorization request was
approve or denied.
Enhanced patient satisfaction by efficiently managing the front desk operations and addressing inquiries in a timely manner. - Streamlined appointment scheduling for improved patient flow and reduced wait times.
Education
Master of Science - Health Services Administration
Barry University
Miami, FL12.2025
Bachelor of Science - Biology
Florida International University
Miami, FL12.2018
Associate of Science - Biology
Miami Dade College
Miami, FL12.2013
Skills
- Interpersonal Communication
- Critical Thinking
- Bilingual in Spanish/English
- Proficient in Microsoft Windows, Office, Word, Outlook, Power Point and Excell
- Proficient in the use of medical software: Cerner
- Medical terminology
- Costumer Service
- Active Listener
- Scheduling
- Data Entry
- Proficient use of CPT and ICD-10 codes
- Time Management
Certification
- Awarded Member of the National Society of
Leadership and Success. - Awarded the Care Spotlight award by Jackson Behavioral Health Hospital for my outstanding services and work with the Veterans Affair Hospital on March 31, 2022.
Timeline
Outpatient Specialist & Community Health Services
Jackson Behavioral Health Hospital
09.2019 - Current
Referral Coordinator
Miami Urgent Care
03.2019 - 09.2019
Master of Science - Health Services Administration
Barry University
Bachelor of Science - Biology
Florida International University
Associate of Science - Biology
Miami Dade College