LUCIA REYES
Mableton,GA
Summary
Proactive and reliable multitasker with excellent organization skills and ability to prioritize patient needs and coordinate daily basic care needs. Highly motivated team player with excellent written and verbal communication skills, attention to detail, and passion for process improvement efforts. Seeking a position in a reputable health care facility with a team-oriented focus that is supportive of professional growth and conducive to challenging opportunities.
Overview
17
17
years of professional experience
Work History
Prior Authorization Specialist
Laureate Medical Group at Northside
04.2023 - Current
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up
- Develop and implement prior authorization workflow, policies and procedures
- Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
- Review requests for pre-authorization and ensure that they are properly and closely monitored
- Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
- Manage correspondence with insurance companies, physicians, specialists and patients as required
- Create patients' records and accounts and ensure the pre-authorization information is properly updated in them
- Secure patients' demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation
Billing Charge Poster
Laureate Medical Group at Northside
10.2020 - 04.2023
- Responsible for data entry from billing encounter forms and auto charge posting, updating the patient information and handling all third-party billing appropriately
- Responsible for processing the practice's professional charges daily
- Code information consistent with procedures performed and diagnosis made
- Post hospital charges as needed
- Post fee sheets daily
- Determine the total charge on each fee sheet
- Balance fee sheets and money collected before and after posting
- Run report for end-of-day close out daily
- Balance and close batches daily
- Add/change/delete CPT and ICD codes to the system as needed
Insurance Verifier
Laureate Medical Group at Northside
10.2016 - 10.2020
- Contacts insurance companies to determine patient's eligibility and coverage for office visits
- Contact pre-certification companies to initiate per-certification and obtain approval of confinement
- Documents appropriate information regarding benefits to be received by check-out, and the subsequent financial responsibility of the client
- Demonstrates support for management staff
- Monitors department backlog and assumes additional workload to maintain a zero backlog
Intake Specialist
Family Health Centers of Georgia
07.2011 - 10.2016
- Provided prompt and attentive intake services
- Process paperwork for new clients efficiently and in accordance with protocols
- Communicate policy information in a clear and detailed manner
- Duties include answering telephone calls, scheduling appointments for initial and return visits, insurance verification, process sliding fee paperwork, assisting with the medical records team, and submitting charges for billing for multiple departments
- Supporting clinical roles involving back office operations
- Knowledgeable of and compliant with current JACHO and OSHA standards
Medical Assistant
Alpha OB/GYN
08.2008 - 12.2010
Education
Diploma -
South Cobb High School
Austell, GADiploma - Medical Assisting
Everest Institute
Marietta, GA01.2008
Skills
- Bilingual Spanish and English
- Multi-patient assignments
- Anticipating providers' needs
- Microsoft Word
- Microsoft Excel
- Electronic medical records
- Nextgen
- EClinicalWorks
- Allscripts
- Medical terminology
- ICD 9
- ICD 10
- CPT codes
- Administrative assisting
- Verifying insurance benefits
- Collecting co pays
- Verifying transactions
- Billing
- Coding
- Patient check in
- Patient checkout
- Answering phone calls
- Scheduling
Timeline
Prior Authorization Specialist
Laureate Medical Group at Northside
04.2023 - Current
Billing Charge Poster
Laureate Medical Group at Northside
10.2020 - 04.2023
Insurance Verifier
Laureate Medical Group at Northside
10.2016 - 10.2020
Intake Specialist
Family Health Centers of Georgia
07.2011 - 10.2016
Medical Assistant
Alpha OB/GYN
08.2008 - 12.2010
Diploma -
South Cobb High School
Diploma - Medical Assisting
Everest Institute
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