Griselda Fernandez
Cutler Bay,FL
Summary
Driven professional with a robust background in healthcare administration, notably at Baptist Health Systems. Excelled in streamlining patient registration, enhancing insurance verification processes, and improving patient service delivery. Proficient in medical terminology and bilingual communication, ensuring efficient and compassionate patient interactions. Demonstrated expertise in regulatory compliance and insurance negotiations, significantly reducing claim denials.
Overview
20
20
years of professional experience
Work History
Financial Clearance Associate 2
Baptist Health Systems
Miami, FL
12.2007 - Current
- Accurately obtains and/or updates registration information avoiding the creation of duplicate/overlay medical records by interviewing patients/others via telephone to include any applicable revisions on active accounts
- Review Quality Assurance system for any real-time/manual errors at the completion of each registration and make any necessary corrections to the account accordingly
- Remains up to date on all managed care contract requirements and accurately verifies all insurance benefits via online or phone within the appropriate timeline and documents appropriately within the registration system
- Validates/obtains authorization/referral/notification, with appropriate CPT and ICD-10 codes from insurance companies/physician office to facilitate and finalize, avoiding claim denials
- Reschedule/cancel any patient appointment due to lack of authorization by following the appropriate protocols
- Determines patient responsibility amount(s) via CPO or applicable tool, to maximize collections and reimbursement
- Notifies the patient or the appropriate individual/department for the collection effort, attempting monetary collections based on department goals
- Explains and provides the Good Faith Estimate letter, when applicable
- Follows the department financial escalation and/or cancellation protocols
- Verify/validate physician orders/prescriptions assuring that it is for the appropriate test/exam/level of care, and that it contains the appropriate sign/symptom/diagnosis and physician signature
- If there are discrepancies on the physician order, contact the appropriate department/physician office for requested revisions
- Schedules patients' appointments/procedures (initial, follow-up, and/or add-on) by phone or in person, utilizing the appropriate scheduling system(s), as applicable
- Consistently communicates to include (but not limited to), exam preparations, arrival times, driving instructions, department location, etc
- Scans/uploads all required documents into the appropriate folder in the scanning system in a timely manner to assure maximum reimbursement and compliance
- Provides healthcare service with care and compassion and is active in service recovery, utilizing appropriate telephone etiquette
- Maintains consistent communication with team lead(s) and Supervisor/Manager with any concerns that may impact business or create dissatisfaction, including payer ineligibility issues, out-of-network, and self-pay patient
Scheduler/Front Desk
Medical Park Diagnostic
Miami, FL
10.2005 - 12.2007
- Scheduling appointments
- Receive incoming calls
- Schedule all diagnostic procedures
- Confirm following day appointments
- Assist patients with their paperwork
Front Desk Receptionist
Neuroscience Consultants
Miami, FL
03.2005 - 09.2005
- Receptionist/medical records/Insurance Verification/ Front Desk Duties
- Provide excellent customer service to a high volume of calls
- Performed patient registration and issued appointments, as necessary
- Insurance verification obtained patients demographics, and collection of copayments
- Schedule appointments and confirm for the next following day
- File patient's charts, update their charts, and file all diagnostic exams
Education
GED - Associates of Science-Medical Insurance Billing and Coding
Dade Medical College
Homestead, FL01.2012
Skills
- Bilingual (English/Spanish)
- Basic knowledge of Microsoft Word
- Basic knowledge of Microsoft Excel
- Basic knowledge of Medical Terminology
- Type 70 wpm
- Excellent interpersonal communication skills
- Excellent customer service skills
- Knowledge of Health Care regulatory guidelines
- Knowledge of insurance contracts
- Knowledge of collections
- Knowledge of authorizations
- Knowledge of pre-certification
- Knowledge of ICD 10
- Knowledge of CPT Code
Timeline
Financial Clearance Associate 2
Baptist Health Systems
12.2007 - Current
Scheduler/Front Desk
Medical Park Diagnostic
10.2005 - 12.2007
Front Desk Receptionist
Neuroscience Consultants
03.2005 - 09.2005
GED - Associates of Science-Medical Insurance Billing and Coding
Dade Medical College