JESSICA GALVAN
Overview
13
13
years of professional experience
Work History
Utilization Review Tech
El Paso Health
01.2023 - Current
- Input all requests for services received via fax or phone into the system accurately for electronically generated authorization and tracking.
- Process authorization request in a timely manner.
- Review documents for completion and collect non clinical data.
- Forward any clinical data received to the Utilization Reviewer.
- Assist with running weekly report.
- Manage quality communication, member support and service representation with members and providers to establish equipment/procedures statuses and expedite auth request.
- Verify fax numbers and system updates. Communicates with requesting provider for any identified need to clarify a request for an authorization, such as CPT codes, ICD10, requested timeframes and member's demographics.
- Followed established procedures to enter and process data correctly.
- Organized, sorted, and checked input data against original documents.
- Assured timely verification of insurance.
Authorization Coordinator
Emergence Health Network
08.2017 - 01.2023
- Demonstrated self reliance by meeting and exceeding work flow needs
- Demonstrated leadership by making improvements to work process and helping train others
- Provides excellent service attention to customers through phone conversations
- Improved operations by working with team members to find workable solutions
- Explained daily process and procedures to new hires, promoting better understanding of job task
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients
- 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
- Followed specific security rules and guidelines to protect patient medical records
- Instructed clinics on amounts covered under benefits plans in easy to understand terminology
- Reviewed denied claims and worked on resolutions to grant approval of coverage
- Performed verification of Medicare, Texas Medicaid, MCO's, and commercial insurances coverage through pertaining portal or by calling insurance
- Verification of 100+ patients weekly by reviewing personnel cases and reviewing insurance coverage information
- Adhered to HIPAA requirements to safeguard patient confidentiality
- Initiate prior authorizations through insurance companies
- Reviewed authorization request and make determinations on correct authorization process.
Medical Assistant/ Scribe
Centro De Salud Familiar La Fe
08.2011 - 07.2017
- Input details about patient histories, physical examinations, medications and other information into electronic chart
- Followed clinician throughout shift in high volume, busy environments
- Evaluated charts, documents and orders and made timely corrections
- Reviewed account information to confirm patient and insurance information is accurate and complete
- Determined correct ICD 10 and CPT codes for use in medical record
- Reconciled clinical notes, patient forms and health information for compliance with HIPPA
- Fielded incoming calls, answered questions and transferred calls internally
- Maintained excellent customer satisfaction through polite, calm demeanor
- Answered calls with friendly and polite approach to engage callers and deliver exceptional customer service
- Took messages from callers and accurately relayed details to intended staff
- Conducted patient interviews to gather health history, vital signs and information about current medical issues
- Prepared client for examination of needed.
Education
Medical Assistant -
International Business College
Skills
- Friendly, Positive Attitude
- Teamwork and Collaboration
- Time Management
- Attention to Detail
- Flexible and Adaptable
- Dependable and Responsible
- Multitasking Abilities
- Excellent Communication
- Critical Thinking
- Computer Skills
- Organization and Time Management
Timeline
Utilization Review Tech
El Paso Health
01.2023 - Current
Authorization Coordinator
Emergence Health Network
08.2017 - 01.2023
Medical Assistant/ Scribe
Centro De Salud Familiar La Fe
08.2011 - 07.2017
Medical Assistant -
International Business College
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