Edith Valladares
Riverton
Summary
Detail-oriented professional with focus on deadlines and skilled in handling medical billing without errors. Knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows. Dedicated professional with successful experience in fast-paced office settings. Responsible, punctual and productive professional when working with little to no supervision.
Overview
11
11
years of professional experience
Work History
DME MEDICAL BILLER
ALPINE HOME MEDICAL
12.2023 - Current
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Collect payments and apply to patient accounts.
- Maintain clear and effective communication with healthcare providers, facilities, and patients to address any billing-related issues or documentation discrepancies.
- Follow up on expired prescriptions to ensure accurate and timely documentation for billing.
- Submit prior authorizations for accounts requiring approval to process claims.
- Work with collection accounts to resolve outstanding payments and facilitate timely reimbursements.
- Ensure proper documentation is obtained and processed in accordance with company policies and regulatory requirements.
- Work with federal and commercial insurances to ensure all claims and processes adhere to proper guidelines and regulations.
- Maintained consistent follow-up on status of prior authorization requests.
Medical Assistant
Intermountain Healthcare
09.2016 - 08.2022
- Performed medical records management, including filing, organizing and scanning documents.
- Assisted doctors and nurse practitioners during patient examinations and procedures.
- Taught patients about medications, procedures, and care plan instructions.
- Collected detailed medical histories and medication information from patients to update records.
- Ensured all patient documentation was accurate and up-to-date for smooth clinical operations.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Submitted prior authorizations for necessary testing, procedures, and surgical interventions to insurance providers.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
Medical Receptionist
Sutter Health
05.2014 - 08.2016
- Managed multi-line phone system
- Transcribed phone messages and relayed to appropriate personnel.
- Coordinated patient scheduling and paperwork needed prior to appointment
- Checked patient insurance, demographic, and health history to keep information current.
- Prepared and processed patient referrals and transfer requests.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Registered and verified patient records with most up-to-date information.
Education
High School Diploma -
Hunter High School
West Valley City, UT05-2012
Skills
- Claims review
- Commercial and Federal insurances
- HIPAA compliance
- Insurance verification
- Claim submission
- CPT code modifiers
- ICD-10 coding
- Medical terminology
- Authorizations and retro-authorizations
- Data entry
- Records maintenance
- Workflow management
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Full TimeWork Location
HybridRemoteImportant To Me
Career advancementWork-life balanceCompany CultureWork from home optionPaid time offTimeline
DME MEDICAL BILLER
ALPINE HOME MEDICAL
12.2023 - Current
Medical Assistant
Intermountain Healthcare
09.2016 - 08.2022
Medical Receptionist
Sutter Health
05.2014 - 08.2016
High School Diploma -
Hunter High School
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