JREIGHLEN SOARES
San Diego,CA
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
11
11
years of professional experience
Work History
Medical Administrative Assistant
Perlman Clinic
San Diego, california
11.2020 - Current
- I work in our Wellness Department. I work with over 20 providers. I help and assist with nutrition, weight management, endocrinology, pain management, and different licensed therapists.
- Verified accuracy of medical codes on claims prior to submission.
- Answered phones, scheduled appointments, and provided general information to callers.
- Processed referrals from primary care physicians and specialists as needed.
- Handled customer complaints in a professional manner while resolving issues quickly and efficiently.
- Scanned documents into EHR systems according to established protocols.
- Created spreadsheets in Excel for tracking purposes.
- answering over 30 in coming calls and assisting patient's with there care.
- Coordinated meetings between physicians and other healthcare professionals.
- Maintained confidentiality of all patient information according to HIPAA regulations.
- Entered patient demographic information into the Electronic Health Records system.
- Provided administrative support to clinical staff as needed.
- Greeted patients, verified insurance coverage and collected copayments.
- Performed data entry tasks including transcribing dictation of medical reports into electronic health records system.
- Maintained a filing system for patient records and physician orders.
- Prepared patient charts for upcoming appointments, including collecting patient history forms and other relevant documents.
- Updated patient accounts and information daily.
- Coordinated referrals with specialty providers when indicated.
- Coordinated referrals for patients requiring specialty services.
- Processed referrals for specialist care when necessary.
- Coordinated referrals to outside providers when necessary.
- Managed referrals to specialists when necessary and followed up with results from referrals.
- Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
- Provided guidance to providers regarding the prior authorization process.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
- Processed appeals in a timely manner as per policy guidelines.
- Developed relationships with external vendors providing pre-authorization services.
- Assisted with developing policies and procedures related to prior authorizations.
- Maintained accurate records of all authorization activities in the database system.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Reviewed and processed prior authorization requests for medical procedures and medications according to established guidelines.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
- Called insurance companies to verify patient benefits.
- Assessed insurance benefits and determined eligibility criteria.
- Verified patient insurance information and obtained authorizations for services from insurance companies.
Customer Service Representative
HMSA, Hawaii Medical Service Association
Honolulu, HI
10.2019 - 02.2021
- De-escalated problematic members concerns, maintaining calm, friendly demeanor
- Documented conversations with members and providers to track requests, problems and solutions
- Assisted members in making payments on accounts and setting up payment plans
- Fielded members and providers complaints and queries, fast-tracking them for problem resolution
- Provided outstanding service to new and long-standing members and providers by attending closely to concerns and developing solutions
- Asked probing questions to determine service needs and accurately input information into electronic systems
- Made outbound calls to obtain account information
- Answered [100]+ inbound calls per day and directed to individuals or departments.
Retail Associate
Target
Kapolei, HI
11.2019 - 01.2021
- I worked as a General Merchandiser for one year and then got promoted to become a night time closing expert
- Welcomed customers, offered to help locate items and suggested merchandise without being intrusive or pushy
- Kept calm and applied strong problem-solving and interpersonal skills to resolve conflicts
- Stocked and cleaned shelves while maintaining neat and orderly store.
Home Health CNA
Metro Care
Waipahu, HI
10.2013 - 01.2016
- Documented information in patient charts and communicated status updates to interdisciplinary care team
- Supported daily living activities by serving meals, feeding, ambulating and turning over and positioning patients
- Safeguarded patient privacy with strict adherence to HIPAA protocols
- Administered medications and educated patients and families on correct at-home administration
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to regarding on the members health
- Prioritized and organized tasks to efficiently accomplish service goals
- Juggled multiple projects and tasks to ensure high quality and timely delivery
- Reviewing members daily journal
- I had roughly about 10 clients I would help and assisted them with their daily needs.
Medical Assistant
Island Pediatric Associates
Hilo, HI
08.2014 - 01.2015
- Performed preliminary physical tests to accurately record results in patient history summary
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment
- Scheduled appointments for patients via phone and in person
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies
- Organized charts, documents and supplies to maintain team productivity
- Contacted pharmacies to submit and refill patients' prescriptions
- Secured patient information and maintained patient confidence by completing and safeguarding medical records
- Assessed, documented and monitored vital signs for patients within outpatient setting
- Maintained inventory, vaccination and product expiration logs to record updated documentation for tracking purposes
- Collaborated with local pharmacies to resolve and clarify issues with patient medication
- Followed principles of asepsis and infection control to meet patient safety guidelines
- Efficiently performed insurance verification and pre-certification and pre-authorization functions
- Processed and produced ER, OR and portable x-ray information to assist diagnosis
- Inventory vaccines
- Administered vaccines if patient needed vaccines.
Education
Associate of Arts in Liberal Arts -
Hawaii Community College
Hilo, HI05.2014
High School Diploma -
Keaau High School
Keaau, HI05.2008
Bachelor of Arts in Nursing -
University of Hawaii At Hilo
Hilo, HISkills
- Report creation
- Report generation
- Credit card payment processing
- Route management
- Schedule mastery
- Retail sales customer service
- Adaptive team player
- Call Center Operations
- Problem-solving abilities
- Data evaluation
- Business development understanding
- Quality control
- Stockroom procedures
- Courteous demeanor
- Inbound and Outbound Calling
- Microsoft Office expertise
- Store maintenance
- Product organization
- Promotional support
- Charting and clinical documentation
- Multi-line phone operations
- Multi-Line Phone Systems
- Patient Demographics
- Medical Records Management
- Patient Scheduling
- Appointment Coordination
- Medical coding understanding
References
- Trudy Moniz, 808-895-5281
- Sheere Saki, 808-347-9841
- Kristen Kaipo, 808-640-0075
Timeline
Medical Administrative Assistant
Perlman Clinic
11.2020 - Current
Retail Associate
Target
11.2019 - 01.2021
Customer Service Representative
HMSA, Hawaii Medical Service Association
10.2019 - 02.2021
Medical Assistant
Island Pediatric Associates
08.2014 - 01.2015
Home Health CNA
Metro Care
10.2013 - 01.2016
Associate of Arts in Liberal Arts -
Hawaii Community College
High School Diploma -
Keaau High School
Bachelor of Arts in Nursing -
University of Hawaii At Hilo
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