Jacqueline Quinones
Easton,PA
Summary
Accomplished Insurance Precertification Specialist with a proven track record at Lehigh Valley Hospital, enhancing organizational growth through expert management of electronic health records and strong communication. Skilled in insurance verification and proficient in EPIC, consistently ensuring accuracy and confidentiality in patient data handling. Demonstrates professionalism and ethics, significantly improving efficiency and patient service quality.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Insurance Precertification Specialist
Lehigh Valley Hospital
Allentown, PA
09.2021 - Current
- Processed appeals when necessary following denial or rejection of claims due to lack of proper authorization.
- Evaluated clinical criteria against existing health plan guidelines to determine authorization status.
- Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
- Reviewed patient medical records to determine medical necessity for requested services and procedures.
- Collaborated with other departments within the organization as needed to resolve issues or obtain additional information.
- Provided follow-up on pending precertification requests to ensure timely processing.
- Compiled and submitted precertification requests for review by payers in accordance with established timelines.
- Answered telephones and directed calls to appropriate medical or administrative staff.
Front Office Representative
Ron Siegel - State Farm Insurance
Kissimmee, FL
08.2019 - 08.2021
- Performed administrative tasks such as filing documents and updating databases.
- Greeted customers and provided excellent customer service.
- Answered incoming calls from guests seeking assistance or information.
- Resolved customer complaints in a timely fashion.
- Processed payment transactions accurately and efficiently.
- Collected copays and account balance payments and updated account records.
- Provided administrative support to coworkers, taking on additional tasks during high-volume periods.
- Provided administrative support to office staff, improving productivity.
- Managed multi-line phone system efficiently, ensuring timely communication with clients and staff.
- Answered office phone and emails to schedule appointments, answer questions and document information.
Insurance Verification Specialist
St Joseph's Hospital and Medical Center
Clifton, NJ
12.2011 - 07.2019
- Evaluated policies and procedures related to Insurance Verification activities.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Provided timely follow up with payers regarding payment status of claims.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Updated patient and insurance data and input changes into company computer system.
Education
High School Diploma -
Passaic High School
Passaic, NJ06-1993
Some College (No Degree) - Criminal Justice
Passaic County Community College
Paterson, NJSkills
- Prior authorization
- Strong communication skills
- Electronic health records management
- Healthcare regulations
- Professionalism and ethics
- Organizational growth
- Knowledgeable in EPIC
- Microsoft office
- Appointment scheduling
- Data entry
- Eligibility procedures
- Insurance verification expertise
Certification
- Reiki 1 and 2 Practitioner
Timeline
Insurance Precertification Specialist
Lehigh Valley Hospital
09.2021 - Current
Front Office Representative
Ron Siegel - State Farm Insurance
08.2019 - 08.2021
Insurance Verification Specialist
St Joseph's Hospital and Medical Center
12.2011 - 07.2019
High School Diploma -
Passaic High School
Some College (No Degree) - Criminal Justice
Passaic County Community College
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