Delilah Garcia
Lovington
Summary
Talented Prior Authorization Representative with years of implementing strategies to secure authorizations for clinical procedures. Expert delivering continuous clinical quality improvement. Superb influencing skills to communicate with credibility, tact and diplomacy.
Overview
12
12
years of professional experience
Work History
Prior Authorization Representative
Nor Lea Hospital
Lovington
06.2014 - Current
- Reviewed prior authorization requests to ensure compliance with medical necessity criteria.
- Communicated with healthcare providers to gather necessary documentation.
- Processed and tracked authorization requests in electronic health record systems to streamline workflow.
- Educated patients on insurance coverage and prior authorization processes.
- Instructed new team members on operational procedures and software usage.
- Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
- Made outbound calls to insurance companies, patients, and physicians to perform eligibility checks for patients.
- Responded promptly to inquiries from providers, members, and other departments within the organization.
- Maintained accurate records of prior authorizations to support regulatory compliance and facilitate audits.
- Notified ordering providers of denied authorizations.
- Maintained files for referral and insurance information, entering referrals into system.
- Communicated with internal teams regarding changes in policy or procedure related to prior authorization process.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
- Provided timely feedback to physicians regarding authorization status.
- Educated customers about the prior authorization process including applicable deadlines.
Education
Lovington High School
Lovington, New MexicoSkills
- Electronic health records
- Documentation management
- Customer service
- Time management
- Team collaboration
- Communication skills
- Training and mentoring
- Adaptability to change
- Patient education
- Patient insurance authorizations
- Benefit coverage
- Insurance authorization
- Insurance verification
- HIPAA compliance
- Medical terminology
- Healthcare industry
- Prior authorization processes
- Regulatory compliance
Bilingual in English and Spanish on Basic medical Terminology
Languages
English
Full Professional
Spanish
Native/ Bilingual
Affiliations
- Able to multitask between online insurance portals as well as outgoing calls to insurance providers to collect the necessary information needed.
Timeline
Prior Authorization Representative
Nor Lea Hospital
06.2014 - Current
Lovington High School