ERIKA RODRIGUEZ
Austin,TX
Summary
Results-driven Healthcare Administrative Professional with expertise in insurance eligibility and authorization processes. Enhances clinical workflow efficiency and minimizes claim denials through effective problem-solving and communication. Bilingual in English and Spanish, facilitating coordination among patients, providers, and insurance companies to ensure continuity of care.
Overview
20
20
years of professional experience
Work History
Authorization/Eligibility Specialist (Remote)
Austin Radiological Association
11.2013 - Current
- Obtain, validate, and document insurance eligibility and prior authorizations for diagnostic imaging services across multiple modalities, ensuring compliance with payer-specific guidelines.
- Review clinical documentation, CPT/ICD-10 coding, and medical necessity criteria to determine authorization requirements and prevent claim denials.
- Communicate with patients, referring offices, and insurance carriers to collect missing information, clarify benefit coverage, and resolve authorization discrepancies.
- Coordinated with utilization management vendors (e.g., Evicore, AIM, NIA) to secure timely approvals and escalated complex cases to ensure resolution.
- Liaised between clinics, radiologists, scheduling teams, and insurance companies to troubleshoot authorization issues, enhancing workflow continuity.
- Identified trends in payer behavior, outdated plan setups, or recurring authorization barriers and escalated findings to management for targeted process improvements.
- Maintain high accuracy and productivity in a high-volume environment while meeting strict turnaround times.
- Performed data entry into various computer systems including but not limited to EMRs and CRMs.
- Provide fluent bilingual support both Spanish and English to patients via phone, chat and email inquiries.
- Answer, screen and process high volume of calls daily with call management system and web-based communications.
Medical Administrative Specialist
Austin Brain & Spine
01.2007 - 11.2013
- Verified insurance eligibility and obtained authorizations for consultations, procedures, and follow-up care.
- Managed patient medical records, ensuring accuracy and confidentiality of documentation to support effective patient care.
- Coordinated follow-up appointments for established neurosurgery patients, facilitating continuity of care and timely treatment.
- Processed outgoing referrals to specialists, attaching clinical notes and physician documentation to enhance communication and streamline patient transitions.
- Supported front-office operations, including patient intake, chart preparation, and communication with hospitals and specialty clinics.
Education
High School Diploma -
Del Valle High School
01-2000
Completed 2 years of college coursework -
Austin Community College (ACC)
Skills
- Prior Authorizations
- Insurance Eligibility Verification
- Payer policy analysis
- Claim management
- Referral & Order Management
- Revenue Cycle Support
- Coding review
- EMR data entry
- Patient Scheduling
- Medical Records Management
- Provider communication
- Workflow Optimization
- Problem Resolution
- Cross-functional teamwork
- Data entry
- Bilingual support
Timeline
Authorization/Eligibility Specialist (Remote)
Austin Radiological Association
11.2013 - Current
Medical Administrative Specialist
Austin Brain & Spine
01.2007 - 11.2013
High School Diploma -
Del Valle High School
Completed 2 years of college coursework -
Austin Community College (ACC)