LORENA GISELLA Fernandez
SAN JACINTO,CA
Overview
33
33
years of professional experience
Work History
Patient Access Representative
Tenet Healthcare Systems
Palm Springs, CA
05.2008 - Current
- Applied knowledge of payer requirements, utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Verified demographics and insurance information to register patients in computer system.
- Processed patient responsibility estimate determined by insurance at pre-registration.
- Applied HIPAA Privacy and Security Regulations while handling patient information.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Assembled registration paperwork and placed identification bands on patient.
- Submitted fees and claims to insurance companies manually or digitally.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Checked claims for errors, corrected issues and mailed out promptly.
- Accessed patient information through variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Met with patients and their families to discuss medical procedures, medications, treatments and continuing care plans.
- Utilized customer service skills and detailed system knowledge to support hospital and clinic operations.
Insurance Verification Representative
Tenet Healthcare Systems
Palm Springs, CA
05.2008 - Current
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Updated all patient and insurance data regularly and carefully inputted changes into company's computer system.
- Verified that patients had proper insurance coverage prior to any procedures or appointment scheduling.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
- Handled billing related activities focused on medical specialties.
- Oversaw collection of admission, billing and processing documents to meet organizational expectations.
- Contacted other medical facilities to confirm medical histories and prevent inaccurate diagnoses.
Admitting Representative
VALLEY HEALTH SYSTEMS
SAN JACINTO, CA
10.2005 - Current
- Managed patient admissions and discharge from hospital to home care, extended care facility or self-care.
- Determined charges and collected co-pays.
- Checked patient information and insurance coverage.
- Coordinated patient paperwork and charts.
Claims Processor
SHARP HEALTH PLAN
SAN DIEGO, CA
07.2001 - 07.2005
- Documented file notes clearly and concisely in [System].
- Administered standard contract benefits to process pending claims for dental benefits.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Reviewed claims for accuracy before submitting for billing.
- Accurately processed large volume of medical claims every shift.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Sent clinical request and missing information letters to obtain incomplete information.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
- Created master spreadsheet to record procedures, denials and approvals.
- Corresponded with insurance customers and agents to obtain or relay information on account status changes.
- Modified, updated and processed existing policies and claims to reflect changes in beneficiary, amount of coverage and type of insurance.
Medical Claims Processor
AETNA US HEALTHCARE
SAN DIEGO, CA
07.1991 - 07.2001
- Informed customers about billing procedures, processed payments and provided payment option setup assistance.
- Documented file notes clearly and concisely in [System].
- Administered standard contract benefits to process pending claims for dental benefits.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Created master spreadsheet to record procedures, denials and approvals.
Education
High School Diploma -
Bonita Vista High
Chula Vista California06.1986
Skills
- Insurance company knowledgeable
- Payment processing
- Regulatory compliance
- Appointment scheduling
Timeline
Patient Access Representative
Tenet Healthcare Systems
05.2008 - Current
Insurance Verification Representative
Tenet Healthcare Systems
05.2008 - Current
Admitting Representative
VALLEY HEALTH SYSTEMS
10.2005 - Current
Claims Processor
SHARP HEALTH PLAN
07.2001 - 07.2005
Medical Claims Processor
AETNA US HEALTHCARE
07.1991 - 07.2001
High School Diploma -
Bonita Vista High