Jennifer Torres
Paterson,NJ
Summary
Healthcare administration professional with 9+ years of experience in revenue cycle operations. Streamline prior authorizations, verify insurance eligibility, and improve workflow efficiency across EMR platforms. Reduce claim denials and accelerate procedural approvals while maintaining HIPAA compliance.
Overview
9
9
years of professional experience
Work History
Prior Authorization & Billing Specialist
Ridgewood Orthopedics
Ridgewood, NJ
07.2024 - Current
- Assisted physicians in compiling clinical documentation for prior authorization packets, ensuring timely submissions.
- Streamlined approval process by transitioning manual workflows to electronic submissions, enhancing submission speed.
- Tracked pending cases and coordinated follow-ups with insurance carriers to expedite approval timelines.
- Reviewed medical claims for diagnosis, procedure, and modifier accuracy before submission.
- Verified insurance benefits and coverage requirements for surgical and imaging services.
- Collected and submitted medical records to help resolve insurance claim disputes.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Reviewed account details for billing accuracy and compliance
- Applied payment credits, corrections, and refunds to accounts
Billing Supervisor & Front Desk Lead
Next Generation Sports & Spine
Paramus, NJ
04.2021 - 06.2024
- Managed patient scheduling and answered 20+ inbound calls daily to support front desk operations.
- Resolved denied claims by working directly with insurance carriers to ensure timely reimbursements.
- Checked prior authorization requests against clinical protocols and insurance criteria.
- Coordinated peer-to-peer medical necessity reviews to facilitate communication between clinic physicians and insurance directors.
- Entered claims authorizations and patient data into EMR with 100% data accuracy.
Prior Authorization Specialist
GEDNJ
Woodland Park, NJ
06.2019 - 04.2021
- Provided insurance review teams with clinical justification to expedite approval decisions.
- Supported daily pre-certification and prior authorization processing for scheduled procedures.
- Verified patient insurance eligibility and checked health benefits prior to appointments, minimizing billing delays.
- Clarified insurance coverage limits and outlined payment plan options for patients to enhance their understanding.
- Entered data across two separate EMR systems at the same time.
Prior Authorization Specialist
EMG
Totowa, NJ
12.2018 - 05.2019
- Secured insurance authorizations for specialized physician-ordered radiology and diagnostic tests, ensuring timely patient access to necessary procedures.
- Performed high-volume insurance verification, pre-certification, and code entry (CPT/ICD) into EMR, facilitating accurate billing and compliance.
- Scheduled 20–30 clinic and radiology appointments daily while handling 50+ customer inquiries.
Billing Coordinator
Gastro-Surgi Center of New Jersey
Mountainside, NJ
02.2018 - 12.2018
- Applied coding regulations to guarantee correct use of CPT codes, ICD codes, and medical modifiers.
- Audited medical documentation, ensuring clinical provider coding aligned with chart notes for accurate billing.
- Identified provider coding errors, educating clinical staff on documentation requirements to enhance practice reimbursement.
Education
Certificate - Medical Billing and Coding
Berkeley College
Woodland Park, NJ05-2017
Skills
- Billing management
- Insurance verification
- Revenue management
- Medical billing
- Medical coding
- Payment processing
- Patient coordination
- Prior authorization
- Insurance verification
Timeline
Prior Authorization & Billing Specialist
Ridgewood Orthopedics
07.2024 - Current
Billing Supervisor & Front Desk Lead
Next Generation Sports & Spine
04.2021 - 06.2024
Prior Authorization Specialist
GEDNJ
06.2019 - 04.2021
Prior Authorization Specialist
EMG
12.2018 - 05.2019
Billing Coordinator
Gastro-Surgi Center of New Jersey
02.2018 - 12.2018
Certificate - Medical Billing and Coding
Berkeley College