Maria Cerrillo
Rio Rancho,NM
Summary
Skilled Clinical Review Specialist with experience in conducting comprehensive assessments of clinical documentation. Strengths include knowledge of medical terminology, ability to assess patient care compliance and familiarity with healthcare regulations. In previous roles, contributed significantly to improving efficiency by identifying gaps in clinical performance and recommending improvement strategies.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Clinical Review Technician
Prime Therapeutics LLC
Eagan, MN
10.2012 - Current
- Reviewed clinical information to determine medical necessity of medications requested by providers and facilities.
- Processed requests for prior authorization in accordance with company policies and procedures.
- Conducted retrospective reviews on a variety of cases involving utilization management or case management activities.
- Analyzed clinical data, including laboratory results, diagnostic studies, and medication profiles as part of the review process.
- Interacted professionally with other departments within the organization regarding patient care issues.
- Maintained current knowledge of state and federal regulations governing healthcare reimbursement practices.
- Performed data entry for patient profiles, billing information and prescription orders into the pharmacy software system.
- Resolved customer complaints in a timely manner while maintaining professionalism at all times.
- Collaborated with other healthcare professionals such as nurses or physicians regarding drug therapies or treatments for patients.
Education
GED -
Albuquerque High School
Albuquerque, NM04-2006
Skills
- Customer Service
- HIPAA knowledge
- Healthcare knowledge
- Data Entry
- Problem-solving abilities
- Electronic Filing System Organization
- Doctor Communication
- Teamwork and Collaboration
- Protected Health Information
- ICD-10, ICD-9 Coding
Certification
- PTCB Certified Pharmacy Technician
Timeline
Clinical Review Technician
Prime Therapeutics LLC
10.2012 - Current
GED -
Albuquerque High School
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