Loretta Madrid
Lubbock
Summary
Efficient Prior Authorization Representative known for productivity and completing tasks with precision. Skilled in navigating complex healthcare systems, insurance verification, and patient communication. Excel at time management, problem-solving, and adaptability in fast-paced environments. Use these soft skills to ensure smooth authorization processes for patients and providers with several years of experience in Epic.
Overview
15
15
years of professional experience
Work History
Prior Authorization Representative II
CVScaremark
Work from home
09.2024 - Current
- Processed prior authorization requests for medication and services efficiently.
- Reviewed medical records to verify eligibility and coverage criteria.
- Communicated with healthcare providers to gather necessary documentation.
- Collaborated with pharmacy teams to ensure compliance with policies.
- Utilized electronic systems to track authorization progress and updates.
- Resolved inquiries from members regarding claim denials and appeals procedures.
- Made outbound calls to insurance companies, patients, and physicians to perform eligibility checks for patients.
- Responded promptly to inquiries from providers, members, and other departments within the organization.
- Facilitated communication between health plan representatives, providers, and members when needed.
- Clarified patient inquiries and questions to update patient account information in computer system.
- Communicated with internal teams regarding changes in policy or procedure related to prior authorization process.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Collaborated with internal departments to provide account status updates.
- Submitted prior authorization requests electronically or by phone to payers.
- Maintained high level of professionalism when speaking to doctors and insurance companies.
- Performed quality assurance reviews on completed work products before submission to payers.
Medical Assistant
Providence Health & Services
Lubbock
03.2023 - 03.2024
- I assisted in managing medical offices with customer satisfaction, and patient complaints
- I communicated with patients effectively and showed compassion with every patient who came through the doors
- I was a lead medical assistant in a high volume patient clinic
- I completed all paperwork and incident report
- Established new client relationships and increased volume through a comprehensive client satisfaction
- I was responsible for getting all prior authorizations for all in office injections
- Answered phones, scheduled appointments and managed patient flow while greeting visitors in a professional manner.
- Educated patients on healthcare topics such as nutrition and disease prevention methods.
- Ordered medical supplies, maintained inventory logs and restocked exam rooms when needed.
- Cleaned and maintained medical equipment following procedures and standards.
- Organized charts, documents and supplies to maintain team productivity.
- Responded to patient callbacks and phone-in prescription refill requests.
- Scheduled appointments for patients via phone and in person.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
- Verified appointment times with patients, preparing charts, pre-admission and consent forms.
- Explained treatment procedures and physicians' instructions.
- Administered medications under physician's supervision.
- Changed dressings on wounds to prevent infection and check for healing.
- Positioned patients properly during examination or treatment for comfort and safety.
- Educated patients on treatment plans and medication instructions clearly.
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Documented notes during patient visits.
- Organized patient charts before each day's clinic sessions began.
- Assisted with pre-operative preparation of patients including providing instruction about post-operative care plans.
- Filed insurance claims forms in accordance with applicable regulations.
Senior Patient Account Representative
Providence Health & Services
Lubbock
03.2014 - 03.2023
- I was responsible for verifying demographics and insurance eligibility
- I calculated deductibles and co-pays due at the time of service.
- I assisted in getting all prior authorizations for upcoming outpatient procedures
- Provided training and guidance to junior staff members on various accounting topics.
- Scheduled follow-up calls with delinquent customers as needed to collect payments due.
- Assisted with month-end close activities such as reconciling accounts receivable balances.
- Investigated disputed charges and made appropriate adjustments as necessary.
- Performed administrative tasks such as filing documents, preparing reports.
- Processed credit card payments for customers who chose this method of payment.
- Provided customer service to patients and insurance companies for billing inquiries.
- Resolved discrepancies in patient accounts by verifying accuracy of invoices, coding, and other data.
- Processed cash, check, and credit card payments on patient accounts.
- Compared statements against patient files.
Caregiver for Elderly
Interim HealthCare
Lubbock
02.2014 - 12.2014
- I provided in-home healthcare for patients that needed assistance
- I also help them prepare healthy meals gave them information about maintaining health
- I was responsible for driving patients to the doctors offices, making an appointment and confirming them
- Providing top-tier customer service is my main priority to help assist patient in daily living
- Coordinated transportation services for clients when necessary.
- Administered prescribed medications on a timely basis following care plan instructions.
- Assured proper nutrition by preparing meals, grocery shopping and monitoring food consumption levels.
- Provided emotional support for clients who were experiencing depression or anxiety due to their illness or disability.
- Assisted clients with daily living activities such as bathing, dressing, and grooming.
- Performed light housekeeping tasks related to the client's care such as laundry and changing linens.
- Provided companionship for elderly clients by engaging in conversation and participating in recreational activities.
Daycare Teacher
Discovery Depot
Lubbock
10.2012 - 10.2013
- Ensured safety of all children by monitoring playground equipment use.
- Utilized positive reinforcement techniques to promote desired behavior in children.
- Created a positive, nurturing environment for young students.
- Maintained supplies inventory for the classroom including art materials and books.
- Supervised children during meal times, playtime, and other activities.
- Taught basic language skills including reading readiness, phonics, writing.
- Demonstrated excellent organizational skills while managing multiple tasks simultaneously.
- Managed record keeping duties such as attendance records and daily reports of individual child activities.
Cashier
Dollar General
Lubbock Tx
02.2011 - 09.2012
- Issued receipts, refunds, credits or change due to customers.
- Conducted price checks for special orders or discounts as requested by customers.
- Stocked shelves with merchandise when needed.
- Provided excellent customer service while promoting loyalty programs to increase sales potential.
- Greeted customers and answered any questions they had about the store's products and services.
- Maintained cleanliness of checkout area including countertops, registers, windowsills and floors.
- Operated cash register efficiently and accurately, processed payments by cash, check, credit card, gift card or automatic debit.
Education
Medical Assistant certification -
Texas tech university
Lubbock, TexasSome College (No Degree) - General Studies
South Plains College
Levelland, TXSkills
- Medical terminology
- Customer service excellence
- Authorizations
- Positive Attitude
- Team Leadership
- Prior authorization processing
Timeline
Prior Authorization Representative II
CVScaremark
09.2024 - Current
Medical Assistant
Providence Health & Services
03.2023 - 03.2024
Senior Patient Account Representative
Providence Health & Services
03.2014 - 03.2023
Caregiver for Elderly
Interim HealthCare
02.2014 - 12.2014
Daycare Teacher
Discovery Depot
10.2012 - 10.2013
Cashier
Dollar General
02.2011 - 09.2012
Medical Assistant certification -
Texas tech university
Some College (No Degree) - General Studies
South Plains College