Emely Sanchez
Brooklyn,NY
Summary
Accomplished Medical Referral and Prior Authorization Specialist with a proven track record at LaSante Health Center, excelling in healthcare regulations and fostering strong relationships. Demonstrated expertise in insurance verification and referral coordination, coupled with exceptional organization and time management skills, significantly enhancing patient care and service efficiency.
Overview
3
3
years of professional experience
Work History
Medical Referral Specialist
LaSante Health Center
Brooklyn, NY
03.2023 - Current
- Reviewed patient records and verified insurance eligibility.
- Researched providers to determine if they are in-network or out-of-network for the patient's health plan.
- Coordinated referrals with primary care physicians, specialists, and other healthcare providers.
- Prepared referral documents containing patient information, diagnosis codes, treatment plans, and provider information.
- Communicated with patients regarding their referrals and answered any questions they had about the process.
- Maintained databases of active referrals and tracked progress of each case until completion.
- Processed authorization requests from referring physicians in a timely manner.
- Developed relationships with internal departments and external entities related to medical referrals.
- Collaborated with clinical staff to ensure accuracy of all documentation associated with referrals.
- Contacted patients to confirm or reschedule appointments to minimize no-show appointments.
- Tracked referral request progress and resolved issues to maintain smooth processing.
- Completed relevant insurance and other claim forms.
Prior Authorization Specialist
LaSante Health Center
Brooklyn, NY
03.2023 - Current
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Processed appeals in a timely manner as per policy guidelines.
- Maintained accurate records of all authorization activities in the database system.
- Assisted with developing policies and procedures related to prior authorizations.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Coordinated resolutions for issues and appealed denied authorizations.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Notified ordering providers of denied authorizations.
Cashier
Stop and Shop Supermarket
Queens, NY
03.2022 - 03.2023
- Greeted customers and answered any questions they had about the store's products and services.
- Verified that customers were of legal age to purchase alcohol or tobacco products.
- Operated cash register efficiently and accurately, processed payments by cash, check, credit card, gift card or automatic debit.
- Balanced daily transactions on a computerized point-of-sale system.
- Maintained cleanliness of checkout area including countertops, registers, windowsills and floors.
- Provided excellent customer service while promoting loyalty programs to increase sales potential.
- Followed company security procedures for handling large sums of money.
- Performed other duties as assigned by management.
Education
High School Diploma -
Achievement First University Prep
Brooklyn, NY06-2020
Bachelor of Science -
Lafayette College
Easton, PASkills
- Referral Coordination
- Insurance Verification
- HIPAA Compliance
- Medical Coding
- Physician Authorizations
- Medical Terminology
- Time management abilities
- Pharmacy Correspondence
- Relationship Building
- Organization and Time Management
- Team Collaboration
Languages
Spanish
Native/ Bilingual
Timeline
Medical Referral Specialist
LaSante Health Center
03.2023 - Current
Prior Authorization Specialist
LaSante Health Center
03.2023 - Current
Cashier
Stop and Shop Supermarket
03.2022 - 03.2023
High School Diploma -
Achievement First University Prep
Bachelor of Science -
Lafayette College
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