Summary
Overview
Work History
Skills
Additional Information
Timeline
Generic

Genesis Lora

Providence,RI

Summary

Serving diverse needs of patients through active communication and responsive engagement with healthcare services and policymakers. Skilled at analyzing case files and databases to speed up inquiry response times and guide information through appropriate personnel channels. Maintains highest standards of ethics, professionalism and regulatory compliance to ease common stressors and de-escalate potential conflicts.

Overview

9
9
years of professional experience

Work History

Prior Authorization Specialist/Financial Services Representative

Rhode Island Medical Imaging
03.2022 - Current
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Reviewed insurance coverage for patients to determine which party was liable for payment.
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Interviewed applicants and explained scope of different available benefits.
  • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
  • Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
  • Ability to maintain sensitivity to the nuances of collecting money for medical services
  • Communicates out of pocket expenses to the patient and notes accounts accordingly
  • Utilizes CPT codes, HCPC codes and ICD-10 codes in daily workflow

Claims Representative

Providence Community Health Centers
04.2017 - 03.2022
  • Investigated insurance claims denials and appeals.
  • Facilitated communication between patients and various departments and staff
  • Entering patient information into clinical databases and
  • Task management
  • Evaluate authorizations provided in claim submissions for accuracy
  • Applied administrative knowledge and courtesy to explain procedures and services to patients
  • Investigated insurance claims denials and appeals
  • Worked productively in fast-moving work environment to process large volumes of claims
  • Coordinated with contracting department to resolve payer issues
  • Checked documentation for accuracy and validity on updated systems
  • Collaborated with internal departments and external vendors to achieve fast resolution of claims
  • Generated, posted and attached information to claim files

Accounting Clerk

LifeSpan
06.2015 - 03.2017
  • Reviews edits and verifies the accuracy of a variety of accounting records and reports
  • Researches all available sources and makes adjustments as appropriate to reconcile errors
  • Performs clerical functions such as gathering data from many sources in order to prepare and complete a variety of reports and reconciliation of accounts
  • Codes indexes logs classifies and files material requiring knowledge of appropriate coding formats and the department's record processing and maintenance systems
  • Performs routine classifications and coding to appropriate transaction accounts and uploads monthly data to the Automated Financial Accounting system
  • Contacts departments regarding status of accounts payable checks and determines priority of distribution plan
  • Receives calls from vendors and handles or refers problems or concerns regarding status of checks to Accounts Payable Supervisor
  • Distributes all checks as appropriate to internal departments and to outside vendors
  • Files invoices purchase orders and other supporting documentation by priority category and returns to accounts payable
  • Receives money prepares bank deposits and credits appropriate general ledge accounts to various bank accounts
  • Responds to departmental inquiries regarding the receipt coding and documentation of deposits

Skills

  • Insurance Information Collection
  • System Updates
  • Medical Billing
  • Third-party billing
  • Insurance Verification
  • Financial Needs Determination
  • Patient Account Reviews
  • Collection Management
  • Payment Calculation
  • Medical Terminology

Additional Information

  • Computer skills
  • Problem-solving skills
  • Teamwork skills
  • Leadership skills
  • Organizational skills
  • Bilingual (Spanish)


Timeline

Prior Authorization Specialist/Financial Services Representative

Rhode Island Medical Imaging
03.2022 - Current

Claims Representative

Providence Community Health Centers
04.2017 - 03.2022

Accounting Clerk

LifeSpan
06.2015 - 03.2017

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Genesis Lora