Elizabeth Gonzalez
Prosser,WA
Summary
Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Referrals/Authorizations position. Ready to help team achieve company goals.
Overview
29
29
years of professional experience
Work History
Prior Authorization Specialist
Mid Valley Community Clinic
06.2022 - Current
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
Referral Coordinator
Mid Valley Community Clinic
06.2016 - 06.2022
- Scheduled appointments with specialists on behalf of clients.
- Enhanced patient satisfaction with timely coordination of referrals and appointments.
- Provided exceptional customer service, addressing patient concerns and inquiries regarding the referral process.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Served as a liaison between primary care physicians, specialists, and patients to ensure timely access to needed services.
- Kept healthcare providers informed of referral status updates, promoting optimal continuity of care throughout the referral process.
- Responded to patient inquiries to offer timely updates regarding referral status.
Certified Nursing Assistant
Mid Valley Community Clinic
04.1996 - 06.2016
- Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
- Performed accurate documentation of patient information according to established protocols for record-keeping purposes.
- Maintained clean and safe environment, reducing risk of infections and promoting health.
- Skilled at working independently and collaboratively in a team environment.
- Learned and adapted quickly to new technology and software applications.
Education
High School Diploma -
Sunnyside High School
Sunnyside, WA06-1986
Skills
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Terminology
- Effective communication skills
- Patient Referrals
- Medicare and Medicaid knowledge
- CPT coding knowledge
- Medical Office Procedures
- Patient Confidentiality Compliance
- Patient Scheduling
- Precertification requirements
Languages
Spanish
Limited Working
Timeline
Prior Authorization Specialist
Mid Valley Community Clinic
06.2022 - Current
Referral Coordinator
Mid Valley Community Clinic
06.2016 - 06.2022
Certified Nursing Assistant
Mid Valley Community Clinic
04.1996 - 06.2016
High School Diploma -
Sunnyside High School
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