Colleen Marie Jaurequi
JURUPA VALLEY,California
Summary
To obtain a position utilizing my excellent skills and knowledge.
Overview
18
18
years of professional experience
Work History
Utilization Management Coordinator
Inland Empire Health Plan, Utilization Management
05.2017 - 09.2021
- Receive and process request for authorizations
- Check Eligibility and Line Of Business
- Verify medical attachments match the member
- Check authorization history for duplicates
- Verify requesting providers information matches in MEDHok and super search
- Verify address, phone and fax
- Verify servicing provider is in network in super search
- Confirm address, phone and fax is correct
- Add facility is required
- Add diagnosis codes, cpt codes, service catergory and sub category
- Confirm priority status matches request
- Review UM Guide, Job Aids and process aids
- Approve or pend request to nurse
Office Manager
Pacific Pain Care
10.2016 - 05.2017
- Oversees and assists with the daily functions of the front and back office medical clinic
- Including work flow, office staff, performance management and training
- Manage clinic reception and patient service coordination
- Manage facility procedures related to insurance and billing
- Schedule all surgical procedures, manage pre-certifications using ICD 10/CPT Codes, and verify insurance coverage
- Check patients in and out, prepare files, answer phones and Schedule appointments
- Call in prescription refills, schedule MRIs and Cat Scans
- Oversees finances including cash flow, payroll, co-payments and accounts payable
- Submits all prior auths to work comp and private insurances
- Acts as doctors private secretary
CMA/ Surgery Coordinator
Haider Spine Center
08.2013 - 10.2016
- Contact insurance companies to request and obtain authorization for surgery using ICD 10 and CPT codes
- Confirm the percentage the insurance company will pay the surgeon and percentage the patient is responsible for
- Contact workmans compensation adjusters and utilization review companies for claim status
- Submit RFAs to the workmans comp review department
- Submit medical reports, diagnostic testing and conservative treatment records to the pre certification department
- Request and schedule preoperative medical clearance to include CxR, lab work and EKG
- Schedule surgeries and coordinates schedule with doctors, hospital and anesthesiologist
- Submit appeals for surgery if denied
- Schedule post-operative appointments and call in prescriptions
- Collect copays and deductibles
- Post payments received from the patient and insurance companies
- Create ledger, balance all payments received and fill out deposit slip
- Request Durable Medical Equipment; lumbar brace, cervical collar and bone growth stimulator
- Submit request and obtain authorization for spinal cord stimulator trials and psychological evaluations
- Assist the doctor with positioning the patient, set up instruments and supplies for the SCS Trial
- Take chief complaints, perform vitals, verify current medications and allergies
- Answer incoming calls from the patient, check in patients and schedule appointments
Ophthalmic Technician/Scribe
Harvard Eye Associates
10.2005 - 08.2013
- Duties included taking a chief complaint, history and visual acuity test
- Perform refractions, check intra ocular pressure, check angles, check pupils and motility
- Performed Lasik screening workups
- Assist the physician as a scribe and assisted with FDA studies
- Organized all the collection of data and documentation pertaining to the clinical research studies
- Perform diagnostic test; OCT of macula and optic nerve, visual fields, pachymetry, fundus photo, topography and corneal cell count
- Assisted the physician with minor surgical procedures and documented the medical exam into the medical record for the surgeon
- EFax prescriptions, coding, billing, collect copays, balanced all money, check in and out patients and scheduled follow up appointments
- Submit referrals to medical group for authorization
- Scheduled surgical procedures and MRIs
- Answered phone calls from patients regarding questions to exam, RX and diagnostic test results
Utilization Management Coordinator
Kelly Services/First Health
01.2004 - 09.2005
- Processed request for authorization
- Sent out approval letters or denials
- Obtained doctors first report on work comp claims
- Created demographic information for injured worker
- Imputed all information requested by the physician's office
- ICD 9 Codes and CPT Codes
- Contacted physicians office for further medical records to make a determination; MRI's, CT Scans, X-Ray etc
- Scanned all records received
- Forward information to nurse case manager for review
- Followed all work comp cases until they were no longer injured or received a settlement
Education
Bachelor of Science - Healthcare Administration
University of Phoenix
Tempe, AZ07-2026
Saddleback College
Misson Viejo, Ca08.2008
Certified Medical Assistant -
California Paramedical & Technical College
Riverside, Ca05.2000
Skills
- Multitasking efficiency
- HIPAA compliance awareness
- Critical thinking
- Medical terminology
- Teamwork and collaboration
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking Abilities
- Reliability
- Excellent communication
- Verbal and written communication
- Self-motivation
- Analytical thinking
- Active listening
References
- Alexis Negrete, alexis.negrete@puhsd.org, Perris High School, 951-295-3742
- Dora Pando, dora01@verizion.net, Universal Health Systems, 951-809-6650
- Collette Gonzalez, colletter88@gmail.com, Haider Spine Center, 951-217-8561
Timeline
Utilization Management Coordinator
Inland Empire Health Plan, Utilization Management
05.2017 - 09.2021
Office Manager
Pacific Pain Care
10.2016 - 05.2017
CMA/ Surgery Coordinator
Haider Spine Center
08.2013 - 10.2016
Ophthalmic Technician/Scribe
Harvard Eye Associates
10.2005 - 08.2013
Utilization Management Coordinator
Kelly Services/First Health
01.2004 - 09.2005
Saddleback College
Certified Medical Assistant -
California Paramedical & Technical College
Bachelor of Science - Healthcare Administration
University of Phoenix
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