JOANNA ROMERO GARCIA

Efficiently manage and oversee the coordination of benefits and eligibility verification for surgical and medical procedures. Collaborate closely with medical staff, insurance companies, and patients to ensure accurate determination of coverage, pre-authorization, and compliance with payer requirements. Responsibilities include:

• Conducting detailed verification of patient insurance benefits for scheduled procedures.
• Navigating pre-authorization processes to secure timely approval from insurance providers.
• Acting as a liaison between patients, providers, and insurance companies to clarify benefit coverage and out-of-pocket costs.
• Maintaining meticulous records of authorizations and eligibility documentation in compliance with regulatory standards.
• Proactively resolving benefit discrepancies and addressing inquiries to ensure seamless patient experiences.
• Supporting surgical teams with accurate scheduling information and benefit confirmations.
• Patient Advocacy: Provide compassionate support to patients by explaining complex insurance policies and assisting with understanding financial responsibilities.
• Claims Support: Monitor and follow up on insurance claims related to surgical procedures to ensure prompt and accurate reimbursement.
• Cost Estimates: Prepare detailed cost estimates for patients, taking into account insurance coverage, deductibles, and out-of-pocket expenses.
• Team Collaboration: Work closely with clinical and administrative teams to streamline pre-surgery workflows and enhance patient satisfaction.
• Training & Mentorship: Train new staff members on eligibility verification processes and insurance protocols, fostering a knowledgeable and efficient team.
• System Optimization: Utilize electronic health record (EHR) systems effectively to maintain accurate patient and insurance data. Propose process improvements for better efficiency and accuracy.
• 1 year of experience in billing.

Successfully managed and processed prior authorization requests for pain management treatments, ensuring adherence to insurance guidelines and policies.

Verified patient benefits and insurance coverage to confirm eligibility for procedures and medications.

Coordinated referrals to specialists and external providers, ensuring a smooth and efficient patient experience.

*Maintained accurate and thorough documentation, diligently following up on referral statuses to accelerate patient care.

Acted as a key liaison between patients, insurance companies, and healthcare providers, resolving coverage issues and obtaining necessary approvals.

Provided patients with clear education on their benefits, coverage details, and financial responsibilities.

Ensured the accuracy and confidentiality of patient information by meticulously maintaining records within electronic medical record (EMR) systems.

Streamlined office workflows to minimize authorization delays, significantly improving overall team efficiency.

Collaborated effectively with multidisciplinary teams to coordinate comprehensive care plans tailored to patient needs.

Communicated professionally with insurance representatives to clarify and resolve complex coverage policies.

Demonstrated strong problem-solving skills by addressing and resolving intricate authorization and benefit discrepancies.

• Surgery Scheduler:
• Coordinated and scheduled surgical procedures by collaborating with physicians, nursing staff, and patients to ensure availability and preparedness.
• Verified procedural requirements, including pre-surgery documentation, patient instructions, and necessary medical clearances.
• Maintained updated calendars and addressed scheduling conflicts to prevent delays or cancellations.
• Provided patients with detailed pre-operative guidance, enhancing their understanding of the surgical process and expectations.
• Ensured seamless communication between surgical teams, facilities, and patients for logistical coordination.
• Prior Authorization Coordinator:
• Managed all aspects of prior authorization for surgical procedures, ensuring compliance with insurance policies and regulations.
• Submitted and tracked authorization requests, proactively following up to secure timely approvals.
• Verified patient benefits and coverage, identifying potential out-of-pocket costs, and explaining insurance policies to patients.
• Resolved authorization discrepancies and addressed denial cases, advocating for patient needs with insurance providers.
• Maintained accurate records within electronic medical systems to streamline authorization workflows and support billing operations.