FANNY URBAEZ
Jacksonville,FL
Summary
Reliable Prior Authorization Specialist with 20 years of experience working in fast-paced clinical environments. Bilingual professional with extensive experience in insurance prior authorization for patients, finding solutions to issues and tackling work tasks in busy office. Proficiency in medical office procedures and practices. Insurance verification and prior authorizations. Strong administrative skills, including word processing with MS word. Extended Experience with ECW, INTERGY, ATHENA HEALTH, EPIC AND MODMED. Excellent communication, teamwork and interpersonal skills. Knowledge of HIPAA and OSHA compliance standards.
Overview
24
24
years of professional experience
Work History
Prior Authorization Specialist
Seven Bridges Pain Specialists
08.2023 - Current
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Managed high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Assisted in the development of departmental guidelines and procedures for prior authorization processes, improving overall efficiency.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
Procedure Coordinator & Surgery Coordinator/Scheduler
Coastal Spine and Pain Center
07.2018 - 10.2023
- Working and obtaining authorization for different procedures and surgeries, such as kyphoplasty, stimulator trials and implants to be performed at ASC (Ambulatory Surgery Center) or in office
- Obtaining cardiac clearances for different procedures
- Insurance and benefits verification
- Scheduling / rescheduling and canceling appointments
- Procedure scheduling and billings sheets preparation
- Making sure ASC had all correct information for scheduled patients
- Verifying and collecting copays, deductibles and coinsurance
- Answer very busy phones and providing outstanding customer service while handling and resolving patient's various issues and/or concerns.
Front Desk / Office Staff
Coastal Psychiatry
01.2018 - 07.2018
- Scheduling / Canceling appointments
- Answering busy phones and documenting patient's issues and concerns
- Insurance verification / Prior authorizations
- Taking patients vital signs
- Collecting urine samples.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Managed time efficiently in order to complete all tasks within deadlines.
- Organized and detail-oriented with a strong work ethic.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Developed and maintained courteous and effective working relationships.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Front Desk Check In/ Check Out
Memorial Orthopedics Surgery and Sports Medicine
10.2017 - 01.2018
- Check in/out patients, scheduling/rescheduling/canceling appointments
- Collecting patients copay, co-insurance, out of pockets and deductible fees
- Handling very busy phone and documenting patient's issues and concerns
- Insurance Verification and referral acquisition
- Scanning new patient paperwork and photo ID
- Verifying and making sure every patient's demographic information was up to date
- Making sure encounter and demographic sheets are printed and prepared for next day appointments
- Appointments confirmation calls.
Front Desk Check in / Out, New Patient Referrals Coordinator
Coastal Orthopedics Associates
11.2015 - 10.2017
- Scheduled appointments for new and current patients using our EMR system
- Handle new patients referrals by making initial contact and scheduling appointments
- Handle very busy phones, and answering telephone inquiries as well as documenting messages
- Make insurance referrals for patients and / or prior authorizations
- Insurance Verification
- Assist patients sign in for their appointments.
Office Assistant Office Manager/Medical Receptionist/ Front Desk
Family Medical Group
07.2000 - 06.2015
- Assist physicians with patient medical examinations
- Scheduled appointments for new and current patients using our EMR system
- Handle various administrative responsibilities such as accounts payable and billing
- Handle very busy phones
- Answered telephone inquiries and documented messages
- Insurance verification as well as creating insurance referrals for patients and/or prior authorizations
- Handle chart reviews and medical records requests
- Assist patients sign in for their appointments.
Education
Liberal Arts, EMT - Emergency Medical Technology
Borough of Manhattan Community College
New York, NY06.2001
Skills
- Authorizations
- Insurance Verification
- Effective communication skills
- HIPAA Compliance Knowledge
- Electronic Health Records Proficiency
- Medical Office Procedures
- Professionalism and Ethics
- Medical Coding
- Appointment Scheduling
References
Provided upon request
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Prior Authorization Specialist
Seven Bridges Pain Specialists
08.2023 - Current
Procedure Coordinator & Surgery Coordinator/Scheduler
Coastal Spine and Pain Center
07.2018 - 10.2023
Front Desk / Office Staff
Coastal Psychiatry
01.2018 - 07.2018
Front Desk Check In/ Check Out
Memorial Orthopedics Surgery and Sports Medicine
10.2017 - 01.2018
Front Desk Check in / Out, New Patient Referrals Coordinator
Coastal Orthopedics Associates
11.2015 - 10.2017
Office Assistant Office Manager/Medical Receptionist/ Front Desk
Family Medical Group
07.2000 - 06.2015
Liberal Arts, EMT - Emergency Medical Technology
Borough of Manhattan Community College
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