Darlintorres Torres
Penfield
Summary
Experienced healthcare administrative professional with a proven ability to manage multiple priorities, interpret policies, maintain accurate documentation, and communicate effectively with employees, clients and cross functional teams. Recognized for strong organizational skills, attention to detail, professionalism, and the ability to resolve complex issues. Eager to leverage these transferable skills to support employee relations, compliance, and organizational success in a Human Resources role within the healthcare industry.
Overview
11
11
years of professional experience
2
2
Languages
Work History
Referral /Prior Authorization Specialist
URMC (Physical Medicine & Rehab)
Rochester, NY
06.2023 - Current
- Submit a large amount of prior authorization requests for spinal procedures, musculoskeletal procedures and imaging via portals, phone or faxed paper forms
- Determine relevant clinical information needed for submission
- Track authorization through processing and communicate denial options to providers including peer to peers, appeals or resubmission
- Communicate with OR schedulers regarding rescheduling procedures that require additional time to review
- Document authorization progress and outcome in patients chart
- Write appeal letters/ submits appeals
- Demonstrate expert medical knowledge in Physiatry in order to properly answer insurance medical questions to obtain authorization approval
- Persevere with process to ensure as many authorizations are approved as possible without provider intervention
- Answer a large amount of urgent messages and requests from providers, OR schedulers, patients and secretaries efficiently
- Maintain up-to-date knowledge of insurance policies and procedures related to prior authorization requirements
- Resolve obstacles presented by Insurance companies by applying knowledge and experience from previous authorization requests, denials and approvals
- Follow up with insurance companies on the status of pending authorizations
- Demonstrate strong knowledge of medical terminology, ICD-10 diagnosis codes, and CPT codes
- Identify Insurance trends and communicate updates to team members to support consistent authorization practices
- Preform assessment to ensure the appropriate appointment/procedure is scheduled with the appropriate provider
- Preform complex appointment scheduling, link referrals, process outgoing referrals
- Provide patient with appointment and provider information
- Assist in interviewing, candidate selection, training and onboarding of new employees
Physician Support Specialist
URMC (Physical Medicine & Rehab)
Rochester, NY
12.2021 - 06.2023
- Served as the primary point of contact for three physicians, coordinating administrative and patient-related communications
- Managed provider calendar and prioritized appointments and meetings based on provider preferences
- 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/or MyChart 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
- Trained and onboarded new employees
Outpatient Access Specialist
URMC (Physical Medicine & Rehab)
Rochester, NY
03.2020 - 12.2021
- 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 - 03.2020
- Answered and triaged patient calls in order to ensure appropriate routing and timely resolution
- Entered new patient demographics and insurance information into the system
- Verified eligibility and maintained accurate records
- Obtained and reviewed referral documentation and assisted with processing efficiently to facilitate timely initiation of care
- 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
High School Diploma -
East High School
Rochester, NY2009
Skills
- Critical thinking and problem solving
- Ability to work under pressure in fast paced environments
- Professionalism and customer service excellence
- Time management and Multitasking
- Strong organizational and prioritization skills
- Strong communication and teamwork skills
- Knowledge of medical terminology
- Accurate data entry and documentation
Languages
Spanish
Native or Bilingual
Timeline
Referral /Prior Authorization Specialist
URMC (Physical Medicine & Rehab)
06.2023 - Current
Physician Support Specialist
URMC (Physical Medicine & Rehab)
12.2021 - 06.2023
Outpatient Access Specialist
URMC (Physical Medicine & Rehab)
03.2020 - 12.2021
Intake Specialist
Lifetime Home Health Care
06.2015 - 03.2020
Associate in Science (A.S.) - Health Care Administration Candidate
Monroe Community College
High School Diploma -
East High School