Esmeralda Alcala

• Verify patient insurance coverage and benefits across commercial, Medicare, and Medicaid plans.
• Review medical records and clinical documentation to initiate and submit prior authorization requests for procedures, imaging, medications, and specialist visits through athena
• Collaborate with providers, nurses, and billing teams to ensure documentation supports medical necessity.
• Monitored payer responses and followed up on pending, denied, or incomplete authorizations to ensure timely resolution.
• Use payer portals and systems (e.g., Availity, Navinet, eviCore, all insurance portals) to track authorization statuses.
• Document all communications and status updates in the EHR system (e.g., Epic, Cerner, Athena).
• Educated patients on insurance-related delays or requirements, providing guidance on appeals processes to facilitate access to care.
• Assisted billing teams in addressing claim denials by clarifying authorization and eligibility issues, improving overall claim approval rates.
• Managed electronic health records systems to maintain accurate patient information and referral tracking.
• Coordinated appointment scheduling, ensuring timely access to specialty care for patients.
• Facilitated communication between patients and healthcare providers to streamline referral processes.
• Oversaw quality assurance measures in referral management, ensuring compliance with healthcare regulations and standards.
• Scheduled appointments with specialists on behalf of clients.

• Oversaw complete and accurate patient registration, including demographics, clinical backgrounds, insurance information, and referral needs per referral guidelines. Connected with financial reimbursement services to maximize physician and patient satisfaction.
• Assisted patients in problem-solving issues in English and Spanish related to financial or social barriers at the first point of contact, including requesting interpreters, transportation services, or prescription assistance as needed.
• Performed indispensable data screening and maintenance, ensuring the presence and accuracy of operative consent, facility consent, history and physical, all laboratory reports, medical clearance and other required documentation. Responsible for obtaining missing documentation from patients, also helps navigate patients through communication portals(ex: Athena patient portal)
• Conducted essential data screening and maintenance to verify the presence and accuracy of operative consent, facility consent, history and physical, all laboratory reports, medical clearance, and other required documentation. Responsible for obtaining missing documentation from patients, also helps navigate patients through communication portals(ex: Athena patient portal)

• Managed multi-line phone system, verified patient appointment times, prepared patient documentation, collected payments, and sent insurance billing information to ensure timely processing.
• Assisted patients with treatment planning services to align their needs with physician recommendations.
• Coordinated with insurance services to collect balances, process claims, and resolve payment issues, creating financial breakdowns from collected data in Microsoft Office Suite.

• Achieved proficiency in Dentrix Ascend dental practice management software to streamline patient management processes.
• Executed administrative patient duties and managed multi-console telecommunications system to enhance communication efficiency.
• Acted as the first point of contact for patient inquiries and referral services.
• Responsible for record-keeping patient visits, arrivals, and departures in logbooks.

• Performed dental radiographs, intraoral scans, and impressions with Dolphin Imaging software. Prepared and filed all dental models and casts for study.
• Maintained patient confidentiality and safety through strict adherence to HIPAA privacy practices, ensuring trust and compliance.
• Maintained clean and professional clinic environment per OSHA guidelines, contributing to overall patient safety and satisfaction.

Received EMT training in patient transport and documentation, pharmacology, anatomy, basic life support (CPR & AED), airway management, trauma care, and medical emergency procedure.

Participated in Reserve Officers' Training Corps.(Completed and Graduated)