Diane Gomez
Summary
Dedicated healthcare professional with over 10 years of experience in medical field, specializing in healthcare administration and patient record management. Proven expertise in processing authorizations and streamlining administrative processes within fast-paced environments. Committed to leveraging extensive experience to enhance operational efficiency and deliver exceptional patient care. Passionate about driving improvements in healthcare systems to support seamless administrative functions.
Overview
17
17
years of professional experience
Work History
Authorization Specialist
Village MD/Summit Medical Group
02.2017 - 07.2024
- Submit prior authorization request to insurance companies via phone and online portals.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
- Developed strong relationships with insurance representatives to expedite approvals and resolve issues promptly.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
Radiology Scheduler/Registration
RWJ Barnabas Health/Radiology
07.2015 - 01.2017
- Answer 80+ calls daily, scheduling appointments, and transferred calls.
- Accurately scheduled exams for the proper modality, time, device and Radiologist.
- Explain preps to patients, verify patients understand all prep and instruction.
- Coordinated radiology appointments for multiple departments, ensuring optimal resource utilization.
- Reduced patient wait times by effectively managing schedules for multiple radiologists and technicians.
- Facilitated same-day appointments whenever possible by constantly monitoring available time slots and communicating with clinical staff regarding urgent cases.
- Provided excellent customer service to patients, answering inquiries about radiology procedures and billing processes promptly and accurately.
- Improved patient satisfaction with timely and accurate appointment confirmations and reminders.
- Conduct pre-registration.
Admitting Interviewer
RWJ Barnabas Health/Oncology
11.2013 - 07.2015
- Certified Patient Access Representative.
- Interview patient, verify and update relevant information to complete registration.
- Registered outpatient registration, coding and charge entry.
- Verify Insurance and eligibility online or by phone.
- Collect copays and deductibles, record daily batches and payments.
- Obtain authorization and bill for patients appointment.
- Ensure compliance to HIPAA process and hospital confidentiality.
Administrative Assistant/Receptionist
Arthritis & Rheumatology of Essex
09.2011 - 03.2012
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Registered patients verified data and assisted with completing forms.
- Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
- Maintained inventory of office supplies and placed orders.
- Scheduled and confirmed appointments and meetings.
- Maintained business office inventory and equipment, placing and expediting orders for supplies, scheduling equipment service and repairs.
- Maintained medical records in accordance with HIPAA company policies.
Medical Office Assistant/Medical Records
Atlantic Health/Pediatric Endocrinology
09.2007 - 09.2009
- Sorted and distributed all lab results to appropriate physicians.
- Prepared patient charts by gathering and organizing medical records ahead of appointments.
- Improved office communication by promptly relaying messages between patients and healthcare providers.
- Managed the efficient flow of medical records by confirming accuracy, scanning documents into the EHR system, and securely storing physical copies.
- Performed various administrative tasks by filing, copying and faxing documents.
- Supported administrative tasks such as ordering supplies, inventory management, and filing medical documents for streamlined office workflow.
- Processed requests for release of medical records and subpoenas according to HIPAA guidelines.
Education
Certificate - Medical Billing and Coding Specialist, Medical Administrative Assistant, Anatomy and Physiology, Medical Terminology
National Healthcareer Association
01.2005
Skills
- Knowledge of HIPAA and OSHA Regulations
- Healthcare Policy Analysis
- Health Insurance Portability
- Clinical Guidelines
- Medical Terminology
- Medical billing and coding
- Leadership and Team work
- Authorizations
- Insurance billing
- Patient Scheduling and Registration
- Proficiency in Microsoft Word, Excel
- Auditing reports
Timeline
Authorization Specialist
Village MD/Summit Medical Group
02.2017 - 07.2024
Radiology Scheduler/Registration
RWJ Barnabas Health/Radiology
07.2015 - 01.2017
Admitting Interviewer
RWJ Barnabas Health/Oncology
11.2013 - 07.2015
Administrative Assistant/Receptionist
Arthritis & Rheumatology of Essex
09.2011 - 03.2012
Medical Office Assistant/Medical Records
Atlantic Health/Pediatric Endocrinology
09.2007 - 09.2009
Certificate - Medical Billing and Coding Specialist, Medical Administrative Assistant, Anatomy and Physiology, Medical Terminology
National Healthcareer Association
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