Gabriela Alferez
San Diego,CA
Summary
Seeking a position where I can utilize my medical administration skills/automation and interpersonal skills. Able to multi-task and work independently. I am a highly motivated, hard-working, self-starter, who believes in being a team player.
Overview
15
15
years of professional experience
Work History
Patient Biller
UCSD INTERVENTIONAL PSYCHAITRY
10.2023 - Current
- Checked insurance eligibility
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Researched and resolved billing discrepancies to enable accurate billing.
- Worked with multiple departments to check proper billing information.
- Facilitated timely renewals of ongoing authorizations by closely monitoring expiration dates and initiating renewal processes proactively.
- Enhanced communication between healthcare providers and insurance companies, reducing delays in patient treatment approvals.
- Reviewed authorizations from payer to determine approved or denied items.
- Calculated estimated copay based on current insurance benefits.
- Submitted for prior authorization with required documentation to appropriate funding source.
- Maintained consistent follow-up on status of prior authorization requests.
SURGICAL FINANCIAL COUNSELOR
Shiley Eye Institute
03.2021 - 10.2023
- Obtaining surgical authorization for Medical Group and Medical Center
- Surgery scheduling
- Ensure all insurance related information is entered and filled in EPIC in a timely manner.
- Maintained up-to-date knowledge of insurance policies, enabling accurate evaluation of coverage eligibility criteria for patients.
- Ensure to collect payments before the surgery including copay, deductible, out of pocket and other services that are not covered by insurance.
- Primary contact surgical patients and UCSD colleagues regarding insurance benefits.
- Maintained consistent follow-up on status of prior authorization requests.
- Reviewed documentation for accuracy and assessment of necessity.
ADMINISTRATIVE ASSISTANT
Shiley Eye Institute
02.2017 - 03.2021
- Job Responsibilities:
- Schedule appointments
- Assist with check in and check out process
- Screen telephone calls, walk in triage
- Collect copays & payments for contact lens
- Registration
- Verifying insurances (HMOs, PPO’s, Medicare, Medical, Etc.,)
- Obtaining Authorizations / Referrals
- Provide patients accurate information for follow up appointments
CLINICAL ADMINISTRATIVE COORDINATOR
Optum
04.2014 - 02.2017
- Job Responsibilities:
- Processing Claim Assessments
- Processing inpatient authorization request
- Processing outpatient authorization requests
- Update and validate demographic and diagnosis information in Anasazi as needed.
- Purging of documents.
- Efficiently answer incoming calls and provide prompt and courteous service to customers and guests.
- Sort through incoming faxes.
- Running the Insight Survey and transfer comments into spreadsheet
- Entering complaints into the TRES database.
NEW PATIENT COORDINATOR
Comprehensive Pain Management Specialists
01.2014 - 04.2014
- Created and managed an organized system to maintain new patient intakes.
- Created charts for patient’s including verifying insurances and eligibility, verifying referrals to our practice, being the first person of contact from patient to our practice, and calling patient to schedule their first appointment ensuring the best quality of care for patient’s. Implemented an organized work flow between, myself, the medical assistants, and the doctor’s
SENIOR REFERRAL COORDINATOR
Comprehensive Pain Management Specialist
05.2012 - 04.2014
- Job Responsibilities:
- Process appeals and retro authorizations when necessary
- Coordinated referrals to specialist
- Verified insurance eligibility & CPT codes
- Reporting to my manager any insurance changes.
- Provide accurate documentation including physician notes, ICD-9 codes and CPT codes to health insurance
- Request authorizations for HMO and specific PPO insurances
- Request authorizations thru these portals, ACES, IDX, MPMPG, TRIAD, BLUE CROSS, UNITED HEALTHCARE, and UHC TRICARE.
FRONT OFFICE ASSISTANT MANAGER
Results Chiropractic
01.2012 - 05.2012
- Job Responsibilities:
- Answer all incoming calls; assist patients and vendors by providing great customer service in English and/or Spanish.
- Schedule new and existing patient appointments effectively (patients include Insurance – HMO & PPO; Cash & Prepaid Plans; and Workers Comp and Personal Injury Cases); and prepare for the patient visits by pulling charts prior to arrival.
- Ensure the presentation and effectiveness of the office and treatment rooms are clean, efficient and professional at all times.
- Receive and record patient and insurance payments, procedures, and/or products; prepare Daily-Income form and deposit.
- Verify insurance eligibility; explain to patient’s coverage as well as patient financial responsibility and collecting monies due.
- Create scan, fax and email EOB’s for billing and reconciling of patient accounts and special projects.
- Patient visits: Place patient in room, Discharge patient, Assist Dr. with procedures; perform initial evaluation of new patient
- Enter procedures and notes in Medisoft for doctor to ensure appropriate documentation and billing; translating for doctor/pts.
- Assist in the developing of personnel and the improvement of policies and procedures.
REFERRAL COORDINATOR
Dr. Enrique Espinosa, Family Practice Physician
11.2010 - 12.2011
- Job Responsibilities:
- Answering incoming calls
- Scheduling appointments
- Filing of Medical Records and Charts
- Coordinating referrals to specialist for patients and request notes for patient follow-up.
- Verifying insurance eligibility
- Coordinated referrals for home healthcare
- Medical billing
- Requesting authorizations from insurance and include ICD-9 and CPT codes
Education
A.A. Degree - Fashion Business & Technology
Fashion Career College
12.2011
High School Diploma - General Education
Bonita Vista High School
06.2006
Skills
- Bilingual- English/ Spanish
- HIPAA
- EMR: Medisoft, Amazing Charts, Anazasi
- EPIC: Cadence Front Desk 200, Schegistrar 100
- Data entry proficiency
- Billing
- ScanDoc , Adobe Acrobat, Microsoft Word, Outlook, Excel, PowerPoint
- Prior authorization
- Strong communication skills
- Critical thinking
Timeline
Patient Biller
UCSD INTERVENTIONAL PSYCHAITRY
10.2023 - Current
SURGICAL FINANCIAL COUNSELOR
Shiley Eye Institute
03.2021 - 10.2023
ADMINISTRATIVE ASSISTANT
Shiley Eye Institute
02.2017 - 03.2021
CLINICAL ADMINISTRATIVE COORDINATOR
Optum
04.2014 - 02.2017
NEW PATIENT COORDINATOR
Comprehensive Pain Management Specialists
01.2014 - 04.2014
SENIOR REFERRAL COORDINATOR
Comprehensive Pain Management Specialist
05.2012 - 04.2014
FRONT OFFICE ASSISTANT MANAGER
Results Chiropractic
01.2012 - 05.2012
REFERRAL COORDINATOR
Dr. Enrique Espinosa, Family Practice Physician
11.2010 - 12.2011
High School Diploma - General Education
Bonita Vista High School
A.A. Degree - Fashion Business & Technology
Fashion Career College
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