Kimberly Alonzo
Lancaster,CA
Summary
Healthcare operations professional with 10+ years of progressive experience in health plan administration, hospital revenue cycle, case management support, insurance verification, authorizations, eligibility, benefits, and medical documentation. Experienced reviewing and processing healthcare information, researching member and coverage issues, coordinating with internal teams and external providers, and maintaining accurate documentation in fast-paced environments. Detail-oriented, organized, and skilled at resolving complex issues while providing clear and professional customer service.
Overview
13
13
years of professional experience
Work History
Medical Management Assistant
SCAN Health Plan
Long Beach, CA
10.2023 - Current
- Support medical management operations by processing and entering authorization-related information for inpatient and outpatient services.
- Review member data, eligibility, network provider status, and division of financial responsibility (DOFR) to support accurate benefit and service determinations.
- Serve as a resource for internal and external customers by researching benefit plan information and contracted provider details.
- Maintain accurate documentation in designated systems and ensure information is complete, timely, and consistent with established workflows.
- Answer and manage telephone inquiries while meeting established service and turnaround-time standards.
- Coordinate information across departments to support efficient processing of medical management requests and member/provider needs.
Case Management Assistant
Antelope Valley Medical Center
Lancaster, CA
08.2021 - 10.2023
- Monitored hospital accounts and computer systems for admission and continued-stay insurance authorizations.
- Submitted clinical reviews to appropriate review agencies and maintained supporting documentation in the computer system.
- Coordinated retrospective utilization review by tracking accounts requiring review, ordering medical records, and documenting completed reviews, authorizations, and denials.
- Supported discharge planning by coordinating with social workers and interdisciplinary team members to arrange appropriate post-hospital care.
- Maintained accurate records and followed up on authorization and utilization-review requirements to support timely account resolution.
Insurance Verifier
Antelope Valley Medical Center
Lancaster, CA
05.2020 - 08.2021
- Verified patient eligibility and benefits electronically, by telephone, and through payer websites for hospital services.
- Contacted health plans in a timely manner when precertification or authorization was required.
- Estimated patient financial responsibility, including deductibles, copays, and non-covered services.
- Documented benefit verification, payment details, and payer information accurately in hospital software.
- Compiled medical reports and supporting information for specific patient or general office needs.
Patient Admitting Representative
Antelope Valley Medical Center
Lancaster, CA
11.2019 - 05.2020
- Obtained insurance card copies and validated insurance information using eligibility tools.
- Registered patients promptly and accurately, ensuring accounts were complete, compliant, billable, and required minimal correction.
- Verified patient demographics and insurance coverage and collected applicable copays.
- Explained consent forms, patient rights, and registration documentation in a clear and professional manner.
Cashier Assistant
Antelope Valley Medical Center
Lancaster, CA
05.2013 - 11.2019
- Processed cash, check, and credit card transactions with a high level of accuracy.
- Maintained organized, clean, and safe work areas while following established procedures.
- Provided courteous, attentive customer service and resolved routine customer needs.
Education
Diploma - undefined
Antelope Valley High School
Lancaster, CA05-2008
Skills
- Authorization Support
- Benefits & Eligibility Verification
- Medical Record & Documentation Review
- Health Plan Operations
- Provider & Member Communication
- Denials & Authorization Documentation
- Case Management Support
- Data Entry & Systems Documentation
- Research & Issue Resolution
- Customer Service
- HIPAA-Conscious Handling of PHI
Timeline
Medical Management Assistant
SCAN Health Plan
10.2023 - Current
Case Management Assistant
Antelope Valley Medical Center
08.2021 - 10.2023
Insurance Verifier
Antelope Valley Medical Center
05.2020 - 08.2021
Patient Admitting Representative
Antelope Valley Medical Center
11.2019 - 05.2020
Cashier Assistant
Antelope Valley Medical Center
05.2013 - 11.2019
Diploma - undefined
Antelope Valley High School