Karen Garcia Gonzalez
Miami,FL
Summary
Focused Referral Coordinator with extensive HIPAA regulation knowledge and background in customer service and support. Streamline administrative processes and identify best available resources for clientele. Skilled at completing daily assignments and contributing to team success. Always willing to take on any task. Adapts quickly to new needs and policies.
Overview
3
3
years of professional experience
Work History
Insurance Verification Specialist
Advanced Rheumatology Of South Florida
Miami, FL
01.2024 - Current
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Analyzed complex health plan contracts to determine benefit coverage levels for services rendered.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
Referral Coordinator
Centers Of Medical Exellence
Miami, Florida
09.2023 - 01.2024
- Coordinated patient appointments and hospital admissions
- Arranged transportation services to take clients to appointments, counseling and meetings
- Maintained large database of provider services for referral and coordination activities
- Compiled patient records and documentation for submission to referring physicians and healthcare facilities
- Scheduled imaging appointments for our patients, whether the order came for the in house providers or the specialist office
- Received, answered, and responded to telephone calls
- Worked on over 125 referrals a week.
Insurance Verification Specialist
Orlando Heart And Vascular Center
Orlando, Florida
11.2022 - 08.2023
- Prepared all outgoing referrals for a cardiologist office that would see over 200 patients a week with accurate procedure codes, diagnosis codes and patient information
- Carefully reviewed medical records for accuracy as required by insurance companies and other physicians
- Verification of eligibility, deductibles, copays/coinsurance for over 200 patients a week
- Adhered to strict requirements regarding data confidentiality and integrity to avoid information breaches.
Referral Coordinator
Advantage Medical Group
Orlando, Florida
02.2022 - 11.2022
- Contacting organizations and insurance companies to ensure prior approval requirements are met
- Informed patient of the status of their authorizations for their specialist visits, imaging or procedures
- Assuming the advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion
- Ensure that referrals are addressed in a timely manner
- Ensures complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred specialists.
Call Center Representative
Advantage Medical Group
Orlando, Florida
06.2021 - 01.2022
- Taking over 300 calls from customers and being able to provide accurate information to all their questions
- Providing satisfactory answers to customers' questions and concerns
- De-escalating situations involving dissatisfied customers and offering a solution and assistance
- Guiding callers through our work progress such as timelines for referrals and refills
- Navigated multiple computer applications while conversing with customers
- Documented all call information according to standard operating policies and procedures.
Education
High School Diploma -
Hallandale High School
Hallandale Beach, FL05-2020
Skills
- HIPAA Guidelines
- Medical Terminology
- Insurance Knowledge
- Insurance Authorization
- E-clinical
- EMDs
- MDvita
- ICD-10
- Active Listening
- Empathy and Adaptability
- Management Skills
- Excellent Customer Service
- Interpersonal
- Building Customer Loyalty
- Positive Attitude
- Multitasking
- Problem Solving
- Teamwork and Leadership
- Courtesy
- Organizational Skills
- Microsoft/Excel/Powerpoint
- Safety Compliance
- Insurance plan verification
Languages
English
Professional
Spanish
Native/ Bilingual
Timeline
Insurance Verification Specialist
Advanced Rheumatology Of South Florida
01.2024 - Current
Referral Coordinator
Centers Of Medical Exellence
09.2023 - 01.2024
Insurance Verification Specialist
Orlando Heart And Vascular Center
11.2022 - 08.2023
Referral Coordinator
Advantage Medical Group
02.2022 - 11.2022
Call Center Representative
Advantage Medical Group
06.2021 - 01.2022
High School Diploma -
Hallandale High School
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