Escarlin Ramirez
Bridgeport,CT
Summary
Detail oriented healthcare professional with experience in clinical documentation review, prior authorization processing, and provider communication. Skilled at ensuring accuracy, compliance, and timely follow up to support efficient billing and patient care. Highly organized and proactive, eager to gain expertise and launch a career in medical coding and billing.
Overview
4
4
years of professional experience
Work History
Prior Authorization Specialist
Cohere health
Boston , MA
11.2024 - Current
- Managed inbound and outbound communication for physicians, physician office staff, other health providers in a high volume call center taking up to 50 calls per day
- Process prior authorization request for a variety of medical procedures, ensuring that all necessary documentation is complete and accurate
- Document and maintained detailed notes on all prior authorization interactions
- Communicated with health care providers to inform them about the status of an authorization request and informed them of any required clinical information needed to complete reviews
- Ensured timely scheduling of peer to peer reviews to avoid delays in patient treatments
- Followed up with providers to ensure that all required clinical documentation were submitted accurately and on time, minimizing delays in patient care
- Assisted healthcare providers in navigating our portal, ensuring that they are able to submit authorizations correctly for review.
Home Health Aide Scheduler
Hartford Healthcare At Home
Bridgeport , CT
01.2024 - 05.2024
- Built strong working relationships with management and field teams through effective scheduling coordination and clear communication
- Scheduled patient appointments by phone in accordance with care plans, accurately entering information into the electronic scheduling system
- Managed inbound and outbound calls to schedule patient services, and address scheduling needs.
- Collected staff availability and created daily work schedules to ensure adequate staffing coverage across service areas
- Verified insurance eligibility and requested pre-authorizations as required.
- Resolved scheduling conflicts efficiently and professionally to maintain continuity of care.
- Managed appointment rescheduling and cancellations due to staff call-outs, illness, or vacation
- Ensured full compliance with HIPAA regulations and patient confidentiality standards
ESL Teacher
Adam J Lewis Academy
Bridgeport , CT
03.2022 - 11.2023
- Develop and maintain positive relationships with students, parents, teachers and head of school personnel
- Utilized various teaching methods, including lectures, demonstrations, and interactive activities to accommodate diverse learning styles and maximize engagement
- Provided ongoing coaching and support to general education teachers to help them implement language learning programs eectively
- Conducted regular assessments to gather feedback on eectiveness of teaching methods and areas for improvement
- Utilized Spanish language skills to build positive relationships with Spanish-speaking and portuguese-speaking students and families
- Attended professional development workshops to remain informedabout best practices and strategies for English language learners
- Regularly updated and refreshed learning content to ensure it remained relevant and effective
- Identified and suggested resources for English language learners and their families
Education
Master of Science - Education
Cambridge College
Cambridge, Massachusetts, MA06-2019
Bachelor of Arts - Communications
Fairfield University
Fairfield, Connecticut, CT06-2014
Skills
- Clinical documentation review and auditing for accuracy and compliance
- Prior authorization processing and verification
- Provider communication and follow-up to obtain required clinical information
- Attention to detail, with strong record keeping and documentation skills
- Knowledge of healthcare workflows, home health, and hospice processes
- Time management and ability to meet deadlines
- Professional verbal and written communication
- Independent, proactive, and team-oriented work style
- Flexible and adaptable in fast-paced healthcare environments
Timeline
Prior Authorization Specialist
Cohere health
11.2024 - Current
Home Health Aide Scheduler
Hartford Healthcare At Home
01.2024 - 05.2024
ESL Teacher
Adam J Lewis Academy
03.2022 - 11.2023
Master of Science - Education
Cambridge College
Bachelor of Arts - Communications
Fairfield University