Darlin Torres
Penfield,NY
Summary
Professional in healthcare administration with strong background in managing authorization processes. Adept at ensuring compliance, streamlining workflows, and mitigating risks. Consistent track record of fostering team collaboration and achieving results in dynamic environments. Skilled in navigating complex systems, prioritizing tasks, and maintaining high standards of accuracy and efficiency.
Overview
11
11
years of professional experience
Work History
Prior Authorization Specialist
URMC (Physical Medicine & Rehab)
Rochester, NY
01.2023 - Current
- Maintained up-to-date knowledge of insurance policies and procedures related to prior authorization requirements
- Communicated effectively with patients regarding authorization status and required information
- Submitted prior authorization requests for Spinal and Musculoskeletal procedures via Insurance portals and/or phone calls with Insurance companies
- Followed up with insurance companies on the status of pending authorizations
- Answered clinical questions from insurance companies in order to obtain approvals
- Communicated with physicians regarding peer to peers when needed
- Created and submitted appeals for denied cases
- Communicated with schedulers regarding rescheduling procedures that required additional time to review
- Ensured compliance with insurance policies
- Collaborated with healthcare providers to gather necessary documentation for authorization approvals
Physician Support Specialist
URMC (Physical Medicine & Rehab)
Rochester, NY
05.2021 - 01.2023
- Served as the primary point of contact for three physicians, coordinating administrative and patient-related communications
- Managed provider patient schedule to ensure efficient appointment flow and access to care
- Served as the primary point of contact for patients, managing a high volume of inbound calls
- Responded to patient inquiries via phone and resolved concerns in a timely and professional manner
- Scheduled appointments
- Filled out patients disability paperwork
- Pended referrals and prescription requests
- Prepared and submitted prior authorization requests to workers compensation insurance
- Typed up patient out of work/back to work/restrictions letters
- Fax, copy, mail letters
Outpatient Access Specialist
URMC (Physical Medicine & Rehab)
Rochester, NY
05.2020 - 05.2021
- Served as receptionist to all patients
- Completed registration
- Screened patients for Covid-19
- Contacted patients to obtain information needed prior to appointments
- Entered external referrals into system
- Managed insurance verification processes to ensure timely access to services.
- Coordinated patient scheduling and appointment confirmations, enhancing workflow efficiency.
- Informed physicians of patient arrivals
- Assisted patients with intake forms and documentation, improving overall patient experience
Intake Specialist
Lifetime Home Health Care
Rochester, US
06.2015 - 04.2020
- Answered and triaged patient calls in order to ensure appropriate routing and timely resolution
- Entered new patient data into the system
- Fax, copies, take bilingual calls
- Called patients to confirm agreement to services prior to their start of care
- Facilitated initial client assessments to determine care needs and service eligibility
- Coordinated communication among clients, families, and healthcare providers for seamless service delivery
Education
Associate in Science (A.S.) - Health Care Administration Candidate
Monroe Community College
Rochester12-2026
Medical Secretary Certificate - undefined
REOC
US11.2012
Skills
- Critical thinking and problem solving
- Ability to Work in a Team
- Leadership Skills
- Effective Time Management
- Ability to Multitask
- Ability to Work Under Pressure
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
- Data entry
Languages
Spanish
Native or Bilingual
Timeline
Prior Authorization Specialist
URMC (Physical Medicine & Rehab)
01.2023 - Current
Physician Support Specialist
URMC (Physical Medicine & Rehab)
05.2021 - 01.2023
Outpatient Access Specialist
URMC (Physical Medicine & Rehab)
05.2020 - 05.2021
Intake Specialist
Lifetime Home Health Care
06.2015 - 04.2020
Medical Secretary Certificate - undefined
REOC
Associate in Science (A.S.) - Health Care Administration Candidate
Monroe Community College