Juan Garcia
Pomona,CA
Summary
Reliable individual bringing 12 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress.
Overview
11
11
years of professional experience
Work History
Utilization Management Coordinator
PIH Health Hospital
11.2017 - Current
- Performed prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
Medical Assistant
PIH Health Hospital
10.2012 - 11.2017
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
- Verified patient insurance coverage and collected required co-payments.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Obtained and documented patient medical history, vital signs and current complaints at intake.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
Education
Vocational - Medical Assisting
Bryman College
Ontario, CA05.2004
High School Diploma -
Garey High School
Pomona, CA06.1999
Skills
- Patient Health Information Access
- Computerized Maintenance Management Systems
- CPT Coding
- Skilled in EMR / EHR / EPIC / EZ CAP
- Microsoft Office
- HIPAA Compliance
- Patient Data Management Systems
- Process Knowledge
- Utilization Review
- Patient Interaction
- Obtaining Authorizations
- Quality Patient Care
Timeline
Utilization Management Coordinator
PIH Health Hospital
11.2017 - Current
Medical Assistant
PIH Health Hospital
10.2012 - 11.2017
Vocational - Medical Assisting
Bryman College
High School Diploma -
Garey High School
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