DINETRIC FOLI
Aurora,CO
Work Preference
Summary
Facilitated timely patient access to services through effective management of prior authorizations and enrollment processes. Enhanced patient registration and insurance verification efficiency, contributing to improved operational workflows. Achieved seamless Medicaid eligibility determination and business office management.
Overview
17
17
years of professional experience
Work History
Patient Registration / Enrollment Specialist
Peak Vista Community Health Centers
CO
01.2024 - Current
- Perform patient enrollment and registration for new and returning patients
- Verify insurance eligibility, benefits, and coverage for Medicaid, Medicare, and commercial plans
- Determine authorization requirements prior to scheduled services
- Obtain, track, and document prior authorizations and pre-certifications
- Review payer guidelines to ensure medical necessity compliance
- Validate CPT, ICD-10, and HCPCS codes prior to submission
- Communicate insurance and authorization information clearly to patients and providers
- Resolve insurance and authorization issues to prevent appointment delays and denials
Assistant Business Office Manager
Mountain View Post Acute
CO
01.2024 - 01.2024
- Assisted Business Office Manager with daily operations of a post-acute healthcare facility
- Oversaw patient registration accuracy, insurance documentation, and demographic data entry
- Verified insurance coverage and authorization requirements for skilled nursing services
- Monitored accounts to prevent unauthorized services and billing errors
- Supported Medicaid and insurance billing processes and documentation compliance
- Assisted with appeals by gathering insurance verification, authorization, and clinical records
- Maintained compliance with payer, state, and federal healthcare regulations
- Coordinated with clinical staff, billing teams, and external payers
Medicaid Pending Specialist
Pikes Peak Post Acute
CO
01.2023 - 01.2024
- Managed Medicaid enrollment, eligibility verification, and authorization processing
- Verified resident insurance coverage and benefit levels
- Managed Medicaid prior authorizations for skilled nursing and long-term care services
- Tracked approvals, renewals, and authorization expirations
- Investigated and resolved authorization- and eligibility-related denials
- Coordinated with Medicaid offices and managed care organizations
Enrollment Specialist / Authorization Support
eviCore Healthcare
CO
01.2009 - 01.2019
- Enrolled members into healthcare programs and verified insurance eligibility
- Processed prior authorizations for diagnostic imaging, procedures, and specialty services
- Reviewed clinical documentation to confirm medical necessity criteria
- Communicated authorization determinations to providers, members, and internal teams
- Maintained strict compliance with payer policies, timelines, and documentation standards
Education
Associate’s Degree - Medical Insurance Billing
Certificate - Medical Insurance Billing
Skills
Patient Enrollment & Registration
Insurance Verification & Benefits Investigation
Prior Authorizations & Pre-Certifications
Medical Necessity Review
Medicaid, Medicare & Commercial Insurance
CPT / ICD-10 / HCPCS
Authorization Denials & Appeals
Business Office Operations
Revenue Cycle Support
EHR Systems (Epic)
HIPAA Compliance
Patient Access & Scheduling
Timeline
Patient Registration / Enrollment Specialist
Peak Vista Community Health Centers
01.2024 - Current
Assistant Business Office Manager
Mountain View Post Acute
01.2024 - 01.2024
Medicaid Pending Specialist
Pikes Peak Post Acute
01.2023 - 01.2024
Enrollment Specialist / Authorization Support
eviCore Healthcare
01.2009 - 01.2019