DIVENESSA GONZALEZ
Palisades Park,NJ
Summary
Exceptionally focused and dedicated Authorizations Specialist with an excellent customer service record and work ethic. Adept at managing multiple projects with accuracy and professionalism. Adapt easily to changes in priorities, excellent follow-through skills and meticulous attention to detail. Especially skilled at cultivating excellent interpersonal relationships with colleagues, medical staff, patients and family members.
Overview
11
11
years of professional experience
Work History
Care Support Representative
CHE Behavioral Health Services
11.2021 - Current
- Answered incoming calls in a professional manner, responding to inquiries or transferring them as appropriate.
- Coordinated the intake process, ensuring all required documentation was collected and processed.
- Communicated with patients with compassion while keeping medical information private.
- Scheduled and confirmed patient appointments and consultations.
- Assisted our providers, Psychologists and Psychiatrists with administrative duties.
- Provided information to patients regarding their insurance coverage, benefits, and payment options.
- Processed referrals from other healthcare providers in a timely manner.
- Filed paperwork related to patient intake processes accurately and efficiently.
- Collected payments from patients.
- Actively participated in meetings related to new procedures or changes within the department.
- Assisted with training new employees on proper intake procedures.
- Provided information and referrals to clients for additional resources and support services.
- Responded promptly to all incoming emails and calls requests for assistance from Patients.
- Resolved escalated customer complaints in a timely manner.
- Demonstrated strong problem-solving skills to diagnose and troubleshoot technical issues.
AUTHORIZATIONS TEAM LEAD
CAREFINDERS TOTALCARE
HASBROUCK HEIGHTS, NJ
10.2017 - Current
- Responsible for organizing and supervising the daily operations of the Authorization Department; Supervise and monitor the workflow for the team and ensure deadlines are met
- Ensure team follows compliance policies and guidelines
- Ensure all authorizations are processed in a timely manner and communication between all internal departments are conducted efficiently and timely
- Provide constant leadership, support and team training on all insurance authorizations processes and new system requirements
- Efficiently and proactively research and resolve authorization items on Hold
- Proactively identifies, analyzes and resolve problems independently, and reports updates to manager
- Actively communicate with physicians' office staff, insurance personnel, patients and patients' family in a professional manner to ensure speedy and efficient turnaround of authorization.
OFFICE SECRETARY
METROPOLITAN NEUROSURGERY
ENGLEWOOD, NJ
09.2015 - 10.2017
- Scheduled appointments
- Professionally and courteously verified appointment times with patients
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Adeptly managed a multi-line phone system and pleasantly greeted all patients
- Verified patients' eligibility and claims status with insurance agencies
- Pre-certified medical and radiology procedures with insurance agencies
- Maintained strict patient and physician confidentiality
- Precisely evaluated and verified benefits and eligibility
- Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable
- Updated patient financial information to guarantee accuracy.
SCHEDULE COORDINATOR
NEW JERSEY MAGNETIC RESONANCE
ORADELL, NJ
07.2014 - 09.2015
- Schedule and confirm patient diagnostic appointments, surgeries, or medical consultations
- Complete insurance or other claim forms
- Interview patients to complete documents, case histories, or forms, such as intake or insurance forms
- Receive and route messages or documents, such as laboratory results, to appropriate staff
- Transmit correspondence or medical records by mail, e-mail, or fax
- Enter data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment into computer
- Resolve or clarify codes or diagnoses with conflicting, missing, or unclear information by consulting with doctors or others or by participating in the coding team's regular meetings
- Post medical insurance billings
- Review insurance policy to determine coverage
- Contact insured or other involved persons to obtain missing information
- Answer telephones and give information to callers, take messages, or transfer calls to appropriate individuals
- Schedule and confirm appointments for clients, customers, or supervisors.
RECEPTIONIST
CENTRO MEDICO DOMINICANO
NY, NY
06.2013 - 06.2014
- Prepare patients for medical visit documenting vital signs and general medical history, chief complaints, prep and schedule for Colonoscopy and Endoscopy
- Contact insurance for eligibility and for prior authorization for medications, procedures, and provide coding for the visit and diagnosis for each patient
- Prep and assist patient for Hysterectomy, Colposcopy, and Pap test
- Answer phones and transfer calls to the appropriate employees, greet and assist patients, schedule appointments, updating personal and financial information and checking in and dispatching patient
- Assist patient, hospital and insurance with medical records, input documents and information, scanning patient records, labs, and insurance information.
Education
MEDICAL CODING AND BILLING -
LINCOLN TECHNICAL INSTITUTE
NJSkills
- Medisoft
- Medinformatix
- Medics premier
- Medsin
- Medic Software
- Eclinics
- Medics
- CellTrack
- NetSmart
- HHAeXchange EVV
- HMO Portals
- NJ MMIS
- Understanding in insurance concepts, policies and processes for authorization approvals
- Bilingual (Spanish)
- Excellent at making decisions in high pressure situations and delegating efficiently
- Active Listening Skills
- Adept at prioritizing and managing deadlines
- Microsoft Office
- Customer Service
- Problem-Solving
- Staff Training
- Teamwork and Collaboration
- Office Administration
- Schedule Coordination
- Training and mentoring
- Team Development
Languages
Spanish
Professional
Timeline
Care Support Representative
CHE Behavioral Health Services
11.2021 - Current
AUTHORIZATIONS TEAM LEAD
CAREFINDERS TOTALCARE
10.2017 - Current
OFFICE SECRETARY
METROPOLITAN NEUROSURGERY
09.2015 - 10.2017
SCHEDULE COORDINATOR
NEW JERSEY MAGNETIC RESONANCE
07.2014 - 09.2015
RECEPTIONIST
CENTRO MEDICO DOMINICANO
06.2013 - 06.2014
MEDICAL CODING AND BILLING -
LINCOLN TECHNICAL INSTITUTE
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