Darlin Torres

• Maintained up-to-date knowledge of insurance policies and procedures related to prior authorization requirements.

• Determine relevant information needed, based on previous authorization request experience.

• Reviewed medical records thoroughly before submitting them for authorization review process.

• Answer clinical questions in order to obtain approvals.

• Communicate with patients, providers, secretaries, and procedure room schedulers to provide information, answer any questions and give updates on authorizations.

• Assisted in training new staff members on proper processes for obtaining authorizations from insurance companies.

• Participated in regular meetings with management team providing feedback on current trends in the industry.

• Submits requests via Insurance portals, forms or phone to obtain prior authorization approvals for Spinal injections, Musculoskeletal pain injections, Baclofen pump refills, ICRP program, Neuropsych Program, MRI, CT Scans.

• Create and submit appeals for denied cases.

• Resolves obstacles presented by the insurance company by applying knowledge and experience of previous requests, denials and approvals.

• Managed providers schedule

• Served as the primary contact for patients and providers

• Answer patient calls and answered any questions regarding care and upcoming procedures, including handling high stress situations with upset patients

• Scheduled appointments

• Filled out patients disability paperwork

• Completed prior auth requests for workers comp patients

• Typed up patient out of work/back to work/restrictions letters

• Fax, copy, mail letters.

• Filled in all patient calendars at checkout for upcoming appointments

• Scheduled patients MRI and CT scans

• Made changes to providers calendars

• Called insurance companies to obtain prior authorization for in-patient chemotherapy

• Re-scheduled appointments.

• Proficiently navigated through Epic to find appointment slots for urgent cancer patients

• Assisted patients in understanding their financial responsibilities, providing clear explanations of billing procedures and payment options.

• Promoted a welcoming atmosphere for all patients, addressing concerns or questions with empathy and understanding.

• Completed registration

• Obtained demographic and insurance information

• Screened patients for Covid-19

• Contacted patients to obtain information needed prior to appointments

• Enter external referrals into Epic

• Made providers aware of patient arrivals

• Answer and triage patient calls and route properly

• Entered new patient data into the system

• Answer intake questions from patients and doctors offices

• Fax, copies, take bilingual calls

• Maintained high levels of accuracy and compliance in data entry, ensuring all information was correctly entered into the required systems.

• Offered compassionate and attentive guidance to patients during crisis situations.

• Call patients to confirm agreement to services prior to their start of care.