Summary
Overview
Work History
Education
Skills
Timeline
Generic

Crystal Guerra

Fort Worth,TX

Summary

Healthcare Administrator with proven to deliver exemplary level of healthcare service delivery to patients. Coordinate admission and discharge of patients. Plan and implement strategies for developing improved health care management. Proven problem solver and excellent communicator. Strong organizational skills, superb understanding of data collection and performance metrics. Capable Patient Representative dedicated to providing superior support for patients in need of reliable information regarding insurance coverage, finance options and documentation requirements. Well-versed in scheduling and database management functions for streamlined communication and reduced correspondence backlogs. Excels at identifying client needs and concerns to improve engagement strategies and overall service.

Overview

26
26
years of professional experience

Work History

Patient Care Coordinator

Optum
02.2023 - Current
  • Verifies insurance eligibility and benefits on all assigned accounts using electronic verification systems or by contacting payers directly to determine level of insurance coverage
  • Obtains referral, authorization, and pre - certification information and documents this information in system
  • Identifies outstanding balances from patient's previous visits and attempts to collect any amount due
  • Trains staff on computer systems, new processes, payer updates and assigned reporting
  • Functions as a Superuser for primary computer systems
  • Proactively identifies and leads department process improvement opportunities
  • Works on Special Projects as needed
  • Performs the duties of a Patient Access Representative
  • Maintains up - to - date knowledge of specific admission, registration, and pre-registration requirements for all areas
  • GFE Accuracy- Quarterly Self-Pay GFE Accuracy: Review all services scheduled greater than 2 days in advance, when the primary payer is self-pay to ensure compliance with GFE Provisions under the NSA:
  • Flats Rates- Identify and evaluate all current flat rate programs across Dignity Health
  • EFR- Support facilities in reviewing and resolving eFR tasks
  • Insurance Discovery- Research encounters, prior history, contact the patient as appropriate
  • Arizona Scheduling- Traveled to Arizona to help Order Sorting & labeling
  • Scheduling Patients.
  • Maintained confidentiality of patient data and condition to safeguard health information.
  • Communicated with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures.
  • Monitored patient health records for accuracy to meet compliance with healthcare guidelines.
  • Add insurance and prepare for auth as needed

Patient Access Specialist

Emerus-Baylor Emergency Medical Center
10.2021 - 02.2023
    • Maintain compliance with EMTALA, DNV, HIPAA and all other hospital and government regulations applicable to the admissions settings
    • Verify insurance benefits for all plans associated with patient, confirming the correct payor and plan is entered into the patient accounting system
    • Scan all registration and clinical documentation into the system and maintain all medical records
    • Obtain Prior Authorization if necessary
    • Respond to medical record requests from patients, physicians and hospitals
    • Maintain cash drawer according to policies
    • Maintain log of all patients, payments received, transfers and hospital admissions
    • Notify Veterans Affair of ER visit or Inpatient Admission
    • Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
    • Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
    • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
    • Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
    • Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
    • Obtained signatures from financial responsibility and treatment procedures from patients or guardians.
    • Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
    • Performed patient pre-admission, admission, transfer and discharge activities.
    • Prepared patient identification band and completed admissions papers.

Unit Secretary/Surgery Scheduling

Texas Health Mansfield-AdventHealth
10.2020 - 12.2021
  • Assures accurate location of patients within the computer
  • Removes patients from the computer promptly upon discharge
  • Monitors PALS list and notifies primary Nurse of new orders and results pending, minimum of every 30 minutes
  • Provides Customer Service rounds, responds to patient requests within scope of practice (i.e.: Ice, blankets, pillows and room temperature)
  • Schedule surgeries for Cath Lab, Surgical Services and GI Lab
  • Ensure referral on file and if not obtain from Doctors office
  • Maintained patient confidentiality in line with HIPAA regulations.
  • Organized paperwork such as charts and reports for office and patient needs.
  • Took pre-operative orders from surgeons and anesthesiologists for smooth operation planning.
  • Obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
  • Maintained rapport with physicians, nurse,s and other healthcare personnel.
  • Maintained current and accurate medical records for patients.
  • Supported office staff and operational requirements with administrative tasks.
  • Provided information for patient admissions and discharges to foster timely processing.
  • Processed lab paperwork and requests according to physicians' orders.
  • Transcribed doctors' medication orders, lab test requests, and care plans.
  • Scheduled appointments and maintained department master calendar to facilitate efficient patient flow.
  • Received and routed laboratory results to correct clinical staff members.
  • Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
  • Registered and verified patient records before triage with most up-to-date information.
  • Coordinated referrals through insurance and other medical specialists and documented details in patient charts.

Patient Care Technician /Health Unit Coordinator

Baylor Scott & White All Saints Medical Center
03.2019 - 02.2021
  • Perform Ekg's
  • Check patient's Blood Sugar and report abnormal results to Nurse
  • Connect patients Tele Monitors
  • Remove patient IV upon discharge
  • Remove Foley upon discharge
  • Perform bladder scan on patients as needed.
  • Obtained patient vital signs and reported results to staff nurse or physician, noting changes from prior measurements.
  • Collected and transported specimens to prepare for lab testing.
  • Responded to patient emergencies with immediate care and notified clinicians to provide comprehensive assistance.
  • Assisted in transferring patients, beds and patient care equipment to other rooms adhering to necessary safety precautions.
  • Helped patients maintain healthy skin by checking wounds, assessing integrity, and bathing bedbound individuals.
  • Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
  • Applied oxygen via nasal cannula, simple masks and nebulizer masks under direction of nurse in charge.
  • Educated patients and families on proper care and treatment to facilitate successful home care.
  • Maintained patient stability by checking vital signs and weight and recording intake and outtake information.
  • Assembles patient chart upon admission and breakdown charts at discharge for medical records for scanning
  • Scan reports and test results correctly and in a timely manner in Epic System
  • Maintain tube station and ensure proper delivery of meds to correct patients
  • Process orders and pick up blood for transfusion for patients
  • Maintain and prepare discharge packets
  • Assisted with processing patient admissions, transfers and discharges.
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Assembled and maintained patient medical records and other documents related to patient care.
  • Scheduled surgeries, managed pre-certifications and verified insurance coverage.
  • Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
  • Created customized care plans, working with hospital staff and families to assess and meet individual needs.

Medical Front Office Receptionist

Legacy ER & Urgent Care
01.2016 - 03.2016
    • Greeting patients in a friendly, courteous, and professional manner both in person and over the phone
    • Verifying patient insurance information from health care insurers and collect co-pay
    • Follow all HIPAA policies and procedures
    • Assist staff and patients with clerical duties as needed, including copying, scanning and faxing documents
    • Creating and maintaining patient files
    • Screens phone calls and directs them to the appropriate individual
    • Confirm all paperwork is filled out correctly provide patients and their family with a customer focused friendly, reassuring and open environment that encourages patient to come back to Legacy ER
    • Checked patient insurance, demographic, and health history to keep information current.
    • Coordinated patient scheduling, check-in, check-out and payments for billing.
    • Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for important details.
    • Obtained payments from patients and scanned identification and insurance cards.

Active Duty Patient Administration Specialist

U.S. Army Medical Corps
09.2007 - 09.2013
  • Taking vital signs, recording accurate med lists and chief complaints, making sure patients are comfortable and feel cared for like family
  • Scheduled surgeries and preop testing
  • Phlebotomy (lots), injections, EKG's, nebulizer treatments, etc
  • Assisting providers with minor surgeries and procedures
  • Calling patients with results, and sounding knowledgeable and respectful over the phone
  • Scheduling tests and obtaining RQI's from insurance companies, taking phone messages and calls from patients and their families, other doctors' offices, laboratories, pharmacies, etc
  • Supervise, perform and direct patient management functions
  • Check In/Out patients
  • Collects admission/clinic fees/copayments/deductibles
  • Schedule appointments for new patients and follow ups
  • Verify insurances and Workman Comp Benefits
  • Knowledgeable of Medicare, Medicaid and other third party insurance
  • Collects and verifies patient demographic and financial information
  • Obtained referrals/preauthorization's/precertification/notifications have been obtained prior to patient's appointment
  • Manage admission, discharge and transfer functions
  • Ensure proper filing of laboratory results, X rays, EKG and other records
  • Record physician orders.

Administrative Clerk

United States Marine Corps Reserves
02.1998 - 06.2005
    • Preparation of naval correspondence and messages
    • Preparation and maintenance of directives
    • Preparation of travel orders, completion of general administrative requirements such as leave
    • Authorizations, identification cards, and preparation and maintenance of command unit punishment books
    • Other duties performed included auditing field service records, verifying information contained in unit diary feedback reports/personnel management reports, preparation of discharge and retirement documents.

Education

Bachelor of Science - Healthcare Administration

Texas Woman's University
Denton, TX
12.2024

Associate of Arts - Healthcare Administration

North Central Texas College
Gainesville, TX
05.2019

No Degree -

AMEDD Center & School
Fort Sam Houston, TX
01.2008

Skills

Computer Skills

  • MEDE MS4 Sorian Cerner Availity
  • EPIC Centricity ZirMed Power Point
  • Recondo Chart Logic Allscripts Excel Word Perfect

Skills

  • Maintaining Financial Records
  • Insurance Authorizations
  • Patient Health Information Access
  • Patient Registration
  • Case Management
  • Payment Plan Options
  • Claim Processing
  • Delinquent Accounts Monitoring
  • Insurance Eligibility
  • Accounts Payable and Accounts Receivable
  • Payment Processing
  • Financial Obligation Determination
  • Referral Coordination
  • Payment Calculation
  • Admitting Coordination
  • Care Plan Recommendations
  • Claims Handling and Coverage Verification
  • Insurance Coordination
  • Patient Reimbursements
  • Insurance Billing
  • Insurance Form Processing
  • Billing Issue Resolution and Support
  • Team Leadership
  • Authorization Verification
  • Information Collection
  • Verifying Eligibility
  • Medical Billing and Collections
  • EMR Updating
  • Insurance Verification

Timeline

Patient Care Coordinator

Optum
02.2023 - Current

Patient Access Specialist

Emerus-Baylor Emergency Medical Center
10.2021 - 02.2023

Unit Secretary/Surgery Scheduling

Texas Health Mansfield-AdventHealth
10.2020 - 12.2021

Patient Care Technician /Health Unit Coordinator

Baylor Scott & White All Saints Medical Center
03.2019 - 02.2021

Medical Front Office Receptionist

Legacy ER & Urgent Care
01.2016 - 03.2016

Active Duty Patient Administration Specialist

U.S. Army Medical Corps
09.2007 - 09.2013

Administrative Clerk

United States Marine Corps Reserves
02.1998 - 06.2005

Bachelor of Science - Healthcare Administration

Texas Woman's University

Associate of Arts - Healthcare Administration

North Central Texas College

No Degree -

AMEDD Center & School

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Crystal Guerra