Kevin Rachal Jr.
Charlotte,NC
Summary
Highly motivated and adaptable healthcare professional with over seven years of progressive experience supporting both clinical and administrative functions in both federal and private healthcare settings. Known for a strong work ethic, exceptional organizational skills, and the ability to thrive in fast-paced, ever-changing environments. Demonstrates flexibility and a proactive mindset when facing new challenges, learning systems, and taking on diverse responsibilities. Bilingual in English and Spanish, with a Bachelor’s degree in Health Administration, and a passion for delivering high-quality service to patients, staff, and leadership. Eager to contribute to meaningful work, and committed to continuous personal and professional growth.
I am now seeking a challenging role where I can leverage my experience, expand my skills, and make a meaningful impact through service, collaboration, and continuous improvement.
Overview
7
7
years of professional experience
Work History
Advanced Medical Support Assistant GS-6, Step-2
U.S. Department of Veterans Affairs
01.2024 - Current
- CUSTOMER SERVICE: Collaborated and provided technical guidance and assistance with clinical and administrative staff to provide exceptional care for veterans, dependents, representatives, and advocates to communicate effectively the full range of VA benefits in a courteous, respectful, and professional manner using ICARE values both in-person and telephonically
- CONDUCTED CLINICAL ADMINISTRATIVE DUTIES: Scheduled appointments, consults, and return to clinic orders for multiple clinics simultaneously including but not limited to primary care, specialty clinics, and ensured the veteran’s data remained accurate as well as the type of appointment i.e. video telehealth, phone, or face-to-face. Ensured that all medical records and any return to clinic orders or consultations were placed within 24 hours, according to our scheduling requirements. Answered phones, entered disposition orders and “no shows” along with clinic cancellations promptly to try and fill the provider’s schedule promptly.
- UTILIZED ELECTRONIC DATA PROGRAMS: Utilized various electronic data process systems such as “VISTA, CPRS, CTM, Microsoft Office 365, and Microsoft Teams” to input data for all interactions with veterans, representatives, and advocates to ensure proper record keeping of encounters was documented and processed. This was done while assisting veterans with scheduling appointments, updating any changes in insurance and collecting demographic information while remaining HIPPA compliant.
- MAINTAINED PROPER KNOWLEDGE OF RELEVANT INFORMATION: Reviewed and remained updated with any relevant laws, regulations, and procedures. Became familiarized with the most up to date information at the VA to ensure that veterans and representatives received accurate information to the best of my knowledge while maintaining a professional demeanor and providing discretion while following all HIPPA and relevant laws with handling their sensitive information such as medical records and other forms of personal documents. Advised employees and supervisors to follow procedures and encourage them to report the incidents especially of any injuries.
- Maintained strict compliance with HIPAA regulations, ensuring the protection of sensitive patient information.
- Promoted effective communication among medical staff by serving as a reliable liaison between physicians, nurses, and administrative personnel.
Prior Authorizations Specialist
Carolinas Center for Surgery
09.2022 - 01.2024
- AUTHORIZATION DUTIES: Responsible for obtaining authorizations for five providers. Processed more than 50 authorizations daily for outpatient hospital, inpatient, ambulatory surgical, and in-office procedures.
- Initiated appeals for denied authorizations and contacted patients to discuss authorizations.
- Responded to clinic questions regarding payer medical policy guidelines and procedures.
- Prioritized incoming authorization requests according to urgency and obtained authorization via payer website or by phone and follow up regularly on pending cases.
- SPECIALTIES ASSIGNED: Pain Management, General Surgery, and Otolaryngology.
- Analyzed and confirmed accuracy of CPT/HCPSC codes and ICD-10 diagnoses in the procedure orders.
- Reviewed chart documentation to ensure patients meet medical policy guidelines. Informed clinical staff of any denials with detailed explanation of what is needed for approval.
- Maintained individual payer files to requirements needed to successfully obtain authorizations.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
Front Office Coordinator
CarolinaEast Physicians Health System
10.2021 - 07.2022
- CUSTOMER SERVICE DUTIES: Screened visitors, vendors, and responded to routine requests regarding needed information.
- Maintained working knowledge and understanding of various insurances' company networks.
- Maintained strict patient confidentiality and adhered to HIPAA regulations.
- SPECIALTIES WORKED IN: Otolaryngology, Audiology, Urology, Internal Medicine.
- Handled financial transactions responsibly, collecting copayments and processing payments with attention to detail.
- Improved patient relations by proactively addressing concerns or complaints with professionalism and empathy.
- Supported administrative tasks such as filing, data entry, and document management to maintain an organized office environment.
- Managed high call volumes effectively, addressing patient inquiries and resolving issues promptly.
- Developed strong relationships with patients, providing empathetic support and assistance throughout their visit.
- Managed inventory of office supplies, ensuring adequate stock levels were maintained for efficient daily operations.
- Contributed to a positive team atmosphere by assisting colleagues when needed, fostering a supportive work environment for all employees.
- Participated in staff meetings and training sessions to stay current on industry best practices and improve overall performance.
- Conducted insurance verification tasks accurately, ensuring proper coverage and minimizing billing errors.
- Provided information to patients, visitors, staff, and vendors to maintain 90%+ patient satisfaction.
Psychiatrist Assistant Case Manager
Affiliated Medical Group, PLLC.
03.2018 - 10.2021
- ASSISTANT DUTIES: Provided case management for 60+ patients daily with one or more chronic behavioral health concerns.
- Proactively identifies high-risk patients and intervenes with the guidance of the Practice provider to improve patients' outcomes.
- Utilized advanced processes in patient assessment, data analysis, and assisted in methods to improve the overall quality and efficiency of patient care for the clinic.
- Ensured that all patient data was complete and was entered into NextGen EHR for reporting.
- Consulted with the patients’ provider if the patients’ condition merits immediate intervention.
- Partnered with the provider to develop, implement, and carry out monitoring in Behavioral Health management for patients. Same day or within 24-hour response to 20+ phone calls and appropriately reviewing with patients’ provider.
- Initiated 15+ Prior Authorizations for medications based on their treatment plan and Diagnosis exceeding the KPI’s put in place by the organization daily.
- Worked with multiple insurance companies to find best affordable medications as a benefit to clients.
- Contributed to a welcoming therapeutic environment by establishing rapport with patients and demonstrating empathy during interactions.
- Maintained up-to-date knowledge of relevant legislation, regulations, and guidelines to ensure compliance with industry standards and best practices.
- Enhanced patient safety by closely monitoring medication administration and promptly reporting adverse side effects to the supervising psychiatrist.
- Improved patient outcomes by providing comprehensive support to the supervising psychiatrist in diagnosing and treating mental health disorders.
Education
Bachelor of Science - Health Administration
University of Phoenix
10.2021
Skills
- Conflict resolution techniques
- HIPAA compliance
- Safety protocols
- Risk management
- OSHA regulations compliance
- Attention to detail
Technologies
- Allscripts EMR
- AthenaOne EHR
- Computerized Patient Record System (CPRS)
- Consult Tracking Manager (CTM)
- Google Workspace
- Integrated Scheduling Solution (I.S.S.)
- Meditech
- Microsoft 365
- NextGen EMR
- Vista GUI Scheduling
- Vista Scheduling Enhancement (VSE),
- Zoom
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Accomplishments
- Received praise and recognition from the CEO and Vice President of the CarolinaEast Health System within 4 months of employment.
- Received ratings of Exceptional and Fully Successful in my current Advanced Medical Support Assistant role at the Department of Veterans Affairs.
Timeline
Advanced Medical Support Assistant GS-6, Step-2
U.S. Department of Veterans Affairs
01.2024 - Current
Prior Authorizations Specialist
Carolinas Center for Surgery
09.2022 - 01.2024
Front Office Coordinator
CarolinaEast Physicians Health System
10.2021 - 07.2022
Psychiatrist Assistant Case Manager
Affiliated Medical Group, PLLC.
03.2018 - 10.2021
Bachelor of Science - Health Administration
University of Phoenix
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