Daisy Ochoa

➢ Manage high-volume referral workflows supporting 67 surgeons across four hospitals, ensuring timely processing and alignment with payer requirements.
➢ Verify insurance eligibility, benefits, and authorization requirements to support accurate reimbursement and prevent claim delays.
➢ Obtain prior authorizations for procedures, imaging, and specialty services by coordinating with Medicare, Medicaid, and commercial payers.
➢ Review incoming referrals for completeness, ensuring all required clinical documentation and insurance information meet payer guidelines.
➢ Track referral and authorization status, proactively following up on incomplete or delayed requests to support timely patient care and revenue cycle performance.
➢ Utilize multiple EHR systems (EPIC, Cerner, Athena, Centricity, Par8o) to document, monitor, and manage referral and insurance workflows.
➢ Collaborate with providers, case managers, and insurance representatives to resolve issues impacting approvals and patient access to care.
➢ Train new staff on referral processes, payer requirements, and system workflows to ensure consistency and accuracy.
➢ Assist patients with scheduling, financial assistance, and navigating insurance-related concerns, delivering high-quality customer service.

➢ Processed insurance verification, prior authorizations, and eligibility assessments.

➢ Managed high-volume front office operations, supporting a 17-provider clinic.

➢ Assisted with ETM (Electronic Transaction Management) edits and claim documentation.

➢ Advocated for non-English-speaking patients through bilingual Spanish/English support.

➢ Processed 100+ medical claims daily, including prior authorizations, coding, and appeals.

➢ Managed corporate accounts, invoices, Explanation of Benefits (EOBs), and settlements.

➢ Collaborated with senior leadership to improve billing workflows and collections.

➢ Provided customer service support to patients and VIP clientele, ensuring billing accuracy.

➢ Monitored claim statuses and followed up on denials, contributing to improved reimbursement and reduced outstanding balances.

➢ Accurately entered billing charges, collected co-pays, and scheduled patient appointments.

➢ Assisted with medical procedures and patient intake, ensuring smooth clinic operations.

➢ Served as master scheduler in Athena EMR, optimizing provider availability.