Luisa Galdamez
Freeport,NY
Summary
Amiable Prior Authorization Representative with 7 years of connecting patients and healthcare providers to vital resources. Dedicated to executing on prescribed medical funding guidelines and policies. Maintains compassionate and sympathetic relations with consumers. Adept at balancing business interests with human-centric service models. Detail oriented authorizations representative who is passionate about excellent patient care.
Overview
8
8
years of professional experience
Work History
Prior Authorization Representative
Western Nassau Diagnostics
- Contacted insurances for benefits and eligibility
- Processed prior-authorizations and submitted requested clinical information to managing entities of authorizations
- Analyzed coverage and guidelines for approval of ultrasounds
- Managed communications with insurances and other medical offices through phone, email, mail and fax
- Daily use of all major insurance portals including Medicare and Medicaid
- Processed authorization appeals for denials with appropriate clinical documentation
- Submitted approved authorizations for billing with accurate documentation of approved services with listed IC10, CPT codes, referrals if needed and supporting clinical notes.
Prior Authorization Representative
Mark Medical Care LLC
02.2018 - 09.2022
- Gained expertise in all aspects of medical billing including filing claims, refund requests, re-filing rejected claims, completing appeals, and adjusting underpayments
- Committed to staying up to date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service, and managed care plans
- Improved medical center efficiency by creating an organized logging system for tracking registrar’s errors in Microsoft Excel/Google Sheet
- Maintained accountability and accurate records by entering adjustments and denials into medical manager system and forwarding information to management to be applied
- Resolve billing errors and apply appropriate ICD-9, CPT-4 codes, charges, and corrected charges
- Maintained accountability and accurate records by entering adjustments and denials into medical manager system and forwarding information to management to be applied
- Document patient case histories and insurance details to facilitate payment processing and assist patients in scheduling all necessary appointments.
Customer Specialist
MDS Communications
08.2016 - 06.2017
- Managed variety of customer service call and administrative task to resolve customer issues quickly and efficiently
- Cross-trained and provided back-up for other customer service representatives when needed
- Telephone fundraising for humanitarian and political non-profit organizations
- Ensured data integrity and confidentiality by observing strict State Plan guidelines, eligibility requirements, and adhered to HIPPA Laws.
Care Provider
E and C Services LLC
01.2015 - 02.2016
- Provided a clean, safe, and comfortable environment for the family during shift
- Use exemplary time management
- Provided Home Care for an individual with special needs
- Assist with grooming and feeding
- Manage daily schedule and accompany to various appointments
- Developed and implemented curriculums according to each individual's special needs
- Performed clerical duties and help other workers
- Provide companionship to assigned clients, aimed at keeping their morale high and positive.
Education
Bachelor of Science -
Arizona State University
06.2025
Skills
- Leadership Development
- Insurance Contracts, Appeals, EOB
- Accounts/Claim Reconciliation
- CPT Coding
- Quality Control
- CMS
- Posting and Balancing
- Knowledge of HMO’s, Medicare, and Medicaid
- Microsoft Word
- Healthcare Industry Knowledge
- Retro-Authorizations
- Insurance Verification
Timeline
Prior Authorization Representative
Mark Medical Care LLC
02.2018 - 09.2022
Customer Specialist
MDS Communications
08.2016 - 06.2017
Care Provider
E and C Services LLC
01.2015 - 02.2016
Prior Authorization Representative
Western Nassau Diagnostics
Bachelor of Science -
Arizona State University