Denisse Venzor
Phoenix,AZ
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Authorization Coordinator
Pima Heart Physicians
Tucson
08.2017 - 02.2022
- My role in this position was to verify insurance eligibility with insurance companies and third-party vendors, obtain authorizations for office visits, testing, cardiac rehab, and any other facility procedure requiring an authorization and or referral in a timely manner.
Referral/Authorizations Coordinator
4C Medical Group
09.2015 - 06.2017
- Receive phone calls and fax referral requests from providers
- Verify member eligibility and benefits
- Input all referral requests including ICD-10 and CPT codes into system accurately for electronically generated authorization tracking
- Provide referral authorization to external providers per Departmental Policy and Procedures and specific contracted Client's process
- Request submission of appropriate medical records according to established criteria for requested service(s)
- Issues authorization within appropriate timeframe for routine, urgent and emergent requests
- Coordinate approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable
- Coordinates approved services with Home Health Providers, Plan discharge Planners and Plan Members as delegated or required by Plan
- Is resource person for PCP to refer to network specialist(s)
- Compile monthly departmental statistics
- Distribute correspondence and other information to the appropriate parties or departments
- Maintain appropriate logs, records, and reports as established by Utilization Departmet
- Adhere to company HIPAA policies and procedures
- Ensures integrity of data entry is accurate
- Obtain pre-authorization for in and out-patient procedures, medical devices, and ancillary services as ordered by providers
- Develops and maintains electronic databases that include referring provider details and an issues log to review and solve service delays
- Solve problems independently
- Utilize escalation protocols when needed
- Facilitate effective communication with patients, physicians, referral sources, and healthcare staff.
Surgery Coordinator
Desert Medical Careers
Phoenix
12.2006 - 09.2015
- Coordinate surgery scheduling for patients
- Verify benefits and eligibility for all scheduled surgeries
- Obtain appropriate authorizations
- Complete facility paperwork and special equipment requests
- Document and maintain all correspondence with patients and insurance carriers
- Schedule diagnostic tests
- Collect patient financial responsibility
- Schedule post-op appointments
- Interact with patients, physicians, and staff in a courteous and professional manner
- Obtain surgical clearance for surgery.
Education
High school diploma -
Skills
- Electronic Medical Records
- Bilingual English/Spanish
- Medical Terminology
- Medical Billing
- Microsoft Excel
- Spreadsheets
- Scheduling
- Powerpoint
- ICD-10 knowledge
- Knowledgeable in CPT
- Department Lead
- EMR
- Filing
- Medical Records
- Outlook
- Time Management
- Word
- Medical Coding
- Patient Care
- HIPAA
- Transcription
- Medical Office Experience
- Insurance Verification
- Anatomy Knowledge
- Medical Receptionist
- Databases
- ICD-9
- Bilingual
- Customer service
- Front desk
- Communication skills
- EMR systems
- Windows
- Order fulfillment
- Analysis skills
- Time management
- CPT coding
- Medical billing
- Medical coding
- Quality control
- Organizational skills
- Quality assurance
Certification
Medical Administrative Assistant, 06/01/10, Present
Personal Information
Title: Authorizations Coordinator
Languages
Spanish - Fluent
Timeline
Authorization Coordinator
Pima Heart Physicians
08.2017 - 02.2022
Referral/Authorizations Coordinator
4C Medical Group
09.2015 - 06.2017
Surgery Coordinator
Desert Medical Careers
12.2006 - 09.2015