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Loren Jimenez
Nursing Student Troy/ASN
Prattville,AL
Summary
Caring and compassionate Student Nurse well-versed in anatomy and physiology, nursing fundamentals and medical terminology. Responds to emergencies with grace and calm mentality. Demonstrated success in delivering superior care to multiple patients, balanced with high-volume task load.
Overview
12
12
years of professional experience
14
14
years of post-secondary education
2
2
Certifications
Work History
Authorization Coordinator
American River Home Care
Sacramento, CA
02.2021 - Current
- Maintained consistent follow-up on status of prior authorization requests.
- Reviewed authorizations from payer to determine approved or denied items.
- Submitted for prior authorization with required documentation to appropriate funding source.
- Reviewed documentation for accuracy and assessment of necessity.
- Presented clear and concise explanations of governing rules and regulations.
- Maintained files and controlled records to show correspondence activities.
- Identified issues, analyzed information and provided solutions to problems.
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
Hospice Liaison
Advanced Home Health And Hospice
Sacramento, CA
03.2016 - 02.2018
- Increased program outreach by building strong relationships with educators and community.
- Maintained knowledge of latest requirements and support strategies.
- Monitored, communicated and coordinated objectives of Advanced Home Health and Hospice.
- Collected and analyzed data and feedback to identify opportunities to improve relationship between other entities and business.
- Solved conflicts and addressed issues that occurred between other entities and business.
- Successfully communicated with entities inside and outside of business.
Medical Billing and Collections Specialist
Advanced Home Health
Sacramento, CA
02.2016 - 01.2018
- Compiled and tracked outstanding balances owed to medical facilities.
- Corrected, completed and processed claims for multiple payer codes.
- Processed online and paper appeal submissions and refund requests.
- Processed billing calls and answered questions from patients and third-party carriers.
- Logged charges and payments within BrightTree.
- Executed billing tasks and recorded information in company databases.
- Utilized talents and expertise to complete on-time and accurate monthly closing processes, journal entries and accruals.
- Collected data to complete detailed financial reports for stakeholders and management.
Office Manager
Margaret Portwood, MD
Sacramento, CA
07.2008 - 03.2016
- Established workflow processes, monitored daily productivity and implemented modifications to improve overall performance of personnel.
- Assessed processes and procedures, complying with OSHA and HIPAA regulations.
- Developed and maintained electronic record management systems to analyze and process data.
- Built relationships with physicians to create steady referral pipeline.
- Performed patient assessments and contributed to development of interdisciplinary care plans.
- Implemented onboarding for new employees, which enabled each to effectively learn tasks and job duties.
- Created and implemented organizational policies and procedures.
- Developed policies and procedures for effective practice management.
- Assisted with regulatory issues such as compliance.
- Communicated effectively with staff members, physicians and patients, employing active listening and interpersonal skills.
- Developed close working relationships with front office and back office staff.
- Provided proper scheduling of patients, ensuring timely and effective allocation of resources and calendars.
- Confirmed patient appointments day before scheduled.
- Verified insurance coverage and obtained pre-authorizations.
- Reviewed new patient paperwork before scheduling appointments.
- Scheduled lab tests and collected results.
- Reviewed medical histories and current information to provide accurate information to surgeons.
- Used MediSoft to schedule patients.
- Answered phone calls and messages for 2-physician Physical Medicine & rehab and Neuropsychology medical facility, scheduling appointments and handling patient inquiries.
- Carried out front office duties utilizing data entry skills in framework of medical database.
- Collaborated with assistants and 2 doctors to prepare and set up rooms with adequate supplies and equipment.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
Education
Associate of Science - Chemistry
American River College
Sacramento, CA 08.2007 - 05.2018
Associate of Arts - Psychology
American River College
Sacramento, CA 08.2007 - 12.2019
Associate of Science - Social Sciences
American River College
Sacramento, CA 05.2018 - 12.2019
Skills
Clinical Documentation
Hospice philosophy understanding
Collecting vitals
Data Collection
Medical office administration
Managing deadlines
Professional bedside manner
Medical Records Management
High level of autonomy
Vaccine administration
Medication distribution
Privacy and confidentiality
Patient Management
Observing responses
Tube feedings and medications familiarity
Patient-focused care
Wound care specialist
Companionship and emotional support
Compassionate caregiver
Adaptable
Efficient and reliable team player
Software
Excel
Outlook
Axxess
BrightTree
Medisoft
Medicare
Certification
HIPPA/ OSHA Certified
Timeline
CPR/BLS Certified
08-2021
Authorization Coordinator
American River Home Care
02.2021 - Current
HIPPA/ OSHA Certified
01-2021
Associate of Science - Social Sciences
American River College
05.2018 - 12.2019
Hospice Liaison
Advanced Home Health And Hospice
03.2016 - 02.2018
Medical Billing and Collections Specialist
Advanced Home Health
02.2016 - 01.2018
Office Manager
Margaret Portwood, MD
07.2008 - 03.2016
Associate of Science - Chemistry
American River College
08.2007 - 05.2018
Associate of Arts - Psychology
American River College
08.2007 - 12.2019