Jennifer Torres
Paterson,NJ
Summary
Reliable Prior Authorization Specialist with over 5 years of experience working in fast-paced, clinical environments. Bilingual professional with skill in prior authorization for patients, finding solutions to issues and tackling work tasks in busy office.
Overview
4
4
years of professional experience
Work History
Prior Authorization Specialist/Insurance Verification Specialist
Next Generation Sports & Spine
Paramus, NJ
04.2021 - Current
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Manage over 20 calls per day
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Notified ordering providers of denied authorizations.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Used EMR to input claim, prior authorization and other important medical data into system.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
Prior Authorization Specialist
GEDNJ
Woodland Park, NJ
06.2019 - 04.2021
- Verify benefits and eligibility prior to patients' appointments
- Acquire Pre-Certification and Pre-Authorization from patients' insurance
- Work simultaneously with two EMR systems, to input patient insurance information
- Call patients to discuss their benefits and payment plans
- Communicate effectively with several doctor's office to make sure proper coding is being used
- Give clinicals when needed to insurance companies for faster approval of procedures
Prior Authorization Specialist
EMG
Totowa, NJ
12.2018 - 05.2019
- Acquired insurance authorizations for radiology tests ordered by physicians
- Schedule 20-30 patient appointments for in office and radiology tests
- Efficiently performed insurance verification, Pre-Certification and Pre-Authorization
- Verify benefits and eligibility prior to patients' appointments
- Accurately entered procedure codes, diagnosis codes into EMR
- Assist in generating referrals for patients
- Managed over 50 customer calls per day
Billing Coordinator
Gasto-Surgi Center of New Jersey
Mountainside, NJ
02.2018 - 12.2018
- Review all documentation to ensure coding by provider is supported
- Apply all coding rules and use of CPT and ICD codes and appropriate use of modifiers
- Where providers have made errors or missed coding, use as educational tool for provider(s)
- Assist in educating physicians and staff in requirements of documentation for proper reimbursement
Education
Certificate - Medical Billing And Coding
Berkeley College
Woodland Park, NJ05.2017
Skills
- Detail oriented and quality focused professional trained in medical administrative support Successful track record of handling complicated assignments and administrative/clerical requests Highly experienced in posting deposits/payments and reconciling accounts with high degree of accuracy Offer solid foundation in software application, database management, and data entry; proven ability to readily master new technology Dedicated to maintaining strict patient confidentiality Keyboarding 50 wpm, Data Entry, MS (Word, Excel, Powerpoint, Outlook) Word Perfect, Quickbooks
- ICD-10, CPT, HCPCS Medical and Insurance Terminology
- HIPAA/ Patient Confidentiality
- With capacity to work in fast-paced environments with demonstrated ability to juggle multiple competing tasks, demands while remaining flexible as priorities arise
- Ability to work well independently, under pressure and under tight deadline with limited resources and multiple competing priorities while seeking input when relevant
Languages
English
Spanish
Timeline
Prior Authorization Specialist/Insurance Verification Specialist
Next Generation Sports & Spine
04.2021 - Current
Prior Authorization Specialist
GEDNJ
06.2019 - 04.2021
Prior Authorization Specialist
EMG
12.2018 - 05.2019
Billing Coordinator
Gasto-Surgi Center of New Jersey
02.2018 - 12.2018
Certificate - Medical Billing And Coding
Berkeley College
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