Cristina Martinez
Donna,TX
Summary
Excellent Experience in processing and submitting prior authorization requests for medical services, procedures, diagnostics, and medications in accordance with payer guidelines. Verified insurance requirements and ensured all necessary documentation was accurately obtained. Created, assigned, and tracked PCP referrals and specialty authorizations, ensuring compliance with insurance and organizational standards. Collaborated with clinical and administrative teams to ensure authorization
requirements were met prior to scheduled visits.
Customer Service Representative skilled in managing high-volume inbound and outbound calls, averaging over 60 calls daily while ensuring accurate documentation and appointment scheduling. Experienced Medical Assistant with proficiency in patient care, including taking vitals, administering injections, and addressing physician needs. Insurance Verifier capable of accurately verifying patient eligibility and coverage for additional procedures.
Overview
9
9
years of professional experience
Work History
Customer Service Representative
Advanced Call Center Technologies LLC
Harlingen, Texas
08.2021 - Current
- Processed and submitted prior authorization requests for medical services, procedures, diagnostics, and medications in accordance with payer guidelines.
- Verified insurance requirements and ensured all necessary documentation was accurately obtained and submitted.
- Monitored authorization status and followed up with payers to ensure timely approvals.
- Ensured authorizations were correctly assigned, linked, and documented in the patient's chart and visit
- Assisted customers with inquiries and resolved issues efficiently.
- Managed high-volume calls while maintaining positive customer interactions.
- Documented customer interactions in the tracking system accurately and promptly.
- Answered customer inquiries and provided accurate information regarding products and services.
- Processed insurance claims efficiently and accurately following company guidelines..
- Reviewed documentation to ensure compliance with policies and regulations.
- Collaborated with team members to resolve complex claim issues effectively.
- Analyzed claims data to identify trends and potential fraud indicators.
Receptionist /Insurance Verification Specialist
Valley Pulmonary Group
McAllen, Texas
05.2020 - 07.2021
- Created, assigned, and tracked PCP referrals and specialty authorizations, ensuring compliance with insurance and organizational standards.
- Reviewed real-time eligibility (RTE) for discrepancies, escalating issues to departments to prevent claim denials.
- Processed insurance information and verified coverage for patient services.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Ensured referrals closed appropriately upon visit completion or expiration.
- Processed insurance information, verifying coverage for patient services to ensure accurate billing.
- Coordinated patient appointments by scheduling and confirming details with individuals.
- Conducted comprehensive insurance verifications for patient eligibility and benefits, facilitating seamless access to services.
- Managed multi-line phone system, directing calls to appropriate staff members.
Medical Assistant
donna childrensn clinic
donna, TX
02.2018 - 01.2020
- Collaborated with clinical and administrative teams to ensure authorization
requirements were met prior to scheduled visits. - Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Assisted healthcare providers during patient examinations and medical procedures, ensuring high-quality patient care.
- Administered vaccines and medications following physician and nurse instructions.
- Maintained accurate patient records in electronic health record systems.
- Scheduled patient appointments and coordinated follow-up visits efficiently.
- Educated patients on treatment plans and preventive care measures, enhancing their understanding and compliance.
- Collaborated with clinical and administrative teams to ensure authorizationrequirements were met prior to scheduled visits.
- Administered injections, medications, and treatments following physician instructions.
Education
Medical Assistant - Medical
Valley Grande Institute
Weslaco, TXHigh School Diploma -
Donna North High School
DonnaSkills
- Prior authorization management
- Insurance verification
- Referral management
- Claims processing
- Claim resolution
- Appointment scheduling
- Patient support services
- Customer service
- Call handling
- Benefits verification
Languages
- English
- Spanish
Timeline
Customer Service Representative
Advanced Call Center Technologies LLC
08.2021 - Current
Receptionist /Insurance Verification Specialist
Valley Pulmonary Group
05.2020 - 07.2021
Medical Assistant
donna childrensn clinic
02.2018 - 01.2020
Medical Assistant - Medical
Valley Grande Institute
High School Diploma -
Donna North High School