Summary
Overview
Work History
Education
Skills
Timeline
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Maria Gonzalez

Bronx,NY

Summary

Experienced Health Administrative professional seeking a challenging position in an organization that values education, expertise, and skills. Committed to contributing to team success and delivering exceptional results. Dedicated to providing efficient administrative support and ensuring smooth operations in the healthcare industry. Detail-oriented and passionate about delivering high-quality service to positively impact patient care.

Overview

17
17
years of professional experience

Work History

Patient Financial Specialist I

Memorial Sloan Kettering Hospital
11.2021 - 10.2024
  • Contacted patients prior to their scheduled appointment to acquire demographic and financial information for registration
  • Received calls though ACD system from all patients/PCP and insurance plans, for registration, insurance verification and counseling on financial responsibilities
  • Verified patient insurance eligibility daily in Epic and on Insurance plan websites
  • Financially counseled patients on plan benefits info and coordination of benefits
  • Initiated pre-authorizations for new patient services when needed
  • Advised patients and Primary Care offices on out of network authorization process, initiating authorizations at times for patients for new or past appointment visits
  • Insurance plan coding correctly for all patient’s accounts in IDX
  • Generated Medical Record Numbers as requested by any clinical areas
  • Assigned Projects by upper management such as Virtual Registrations and Reports
  • Mentored and trained New Specialist employee when advised by upper management

Senior Patient Care Coordinator

Weill Cornell Medical Center
02.2019 - 11.2021
  • Responsible for front-end revenue cycle processes, which may include but is not limited to, the check-in/check-out of patients and collection/reconciliation of time-of-service payments, as applicable
  • May also discuss the patient’s responsibility for payments
  • Welcomed patients as they arrive and perform check-in responsibilities: verifying, collecting and confirming insurance and demographic information
  • Verified patient insurance eligibility and obtain necessary pre-authorization numbers, if required, prior to appointment date
  • Obtained referrals from patients PCP or Insurance carriers for visits
  • Facilitated the communication and collection of any fees due from the patient
  • Registered patients within the practice management system
  • Completed full registration for new patients and eligibility verification for all appointments/procedures
  • Resolved registration issues prior to patient appointment to ensure smooth check-in
  • Schedule, confirms, re-schedules and cancels appointments for both new and existing patients using the scheduling application Epic
  • Obtained Authorizations through patients Insurance carriers for PET Scans, CT Scans and MRI appointments
  • Responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual’s provider
  • Entered data in an accurate manner in order to update patient benefit information correctly in EMR and verify that existing information is accurate
  • Consistently reviewed eligibility responses in the insurance verification system
  • Verified insurance coverage in a timely fashion
  • Notify patients and help arrange alternative payment methods when insurance coverage does not cover services
  • Educated patients about the patient portal and encourage patients participation
  • Identify areas of improvement for the front desk and office flow
  • Assisted in the training of new staff members in the practice's standard of operations policies regarding patient care and billing related activities
  • Recommend improvements to workflows to ensure maximum schedule utilization
  • Managed patient chart processes to ensure that information is inputted and scanned properly
  • Post payment information within the practice management system
  • Answer phones, responds to inquiries and triages calls to appropriate personnel
  • Receive, sort and distribute mail
  • Arrive patients in the practice management system to notify the clinical team and escorting patients to their infusion rooms
  • Covered for medical secretaries and duties when needed
  • Worked on special projects as per practice administrator

Physician Referral Specialist

Hospital for Special Surgery, Main Campus
08.2016 - 02.2019
  • Answered all calls on a daily basis from prospective patients, family members, provider offices and inquiries to the Hospital for Special Surgery in a friendly, courteous, and helpful manner
  • Registered new patients, updated demographics and insurance information in Epic and the Kyruus system
  • Verified patients Insurance prior to scheduling with the corresponding physician
  • Use of computerized systems such as EPIC to schedule physician appointments as requested by patients and referring physicians
  • Informed patients of Referral and pre-certifications requirements for office visits and procedures prior to visit and obtained referrals directly when applicable
  • Data entered referrals into the Kyruus system module within HSS
  • Communicated with all sub-specialty divisions to facilitate scheduling of visits
  • Provided backup coverage as needed and performed other related duties as assigned by the Assistant Director
  • Contacted the assistant director when required assistance with difficult or unusual situations when dealing with patients, referring physicians and special requests

Member Services Coordinator

Lighthouse Guild- Guildnet
03.2008 - 11.2014
  • Provided customer service to all members and vendor agencies calling on the Que line on a daily basis
  • Coordinated member's request on DME and supplies, followed up with a member to confirm delivery/receipt of items seven (7) days after order placed
  • Assisted the Nurse Case Managers and Social Workers with their member monthly translations and summaries in Spanish
  • Data entry of Nurse Case Managers requests with DME, home care, nursing visits, physical therapy and hospital discharges
  • Initiated reauthorization requests for all unskilled home care services (PCA), (HHA), PERS, standing incontinent supply requests, standing medication pre-pours and short/long term in network skilled nursing facility stays
  • Assisted with securing grievance/occurrence reports from vendors, facilities, etc
  • Under the direction of the case manager and social worker
  • Assisted with the resolution of member related service issues (i.e
  • Aide no show/late, transportation late/no show, supply request not received, and DME equipment not received) and followed up with the vendor to explain and resolve
  • Reviewed disenrollment reports and identified members listed for their
  • Assigned case manager, terminate all authorizations effective disenrollment date, confirmed receipt of terminated authorization with applicable vendor; submit disenrollment report to on site supervisor for review
  • Assisted in on-call services when needed and Monthly Summary calls to members
  • Data entry of all transportation requests coming through the MCO system into the department inbox
  • Provided supervisor with help on projects as needed

Education

Bachelors in Science - Health Services

Monroe College
Bronx, NY

Associates in Applied Science - Medical Administration

Monroe College
Bronx, NY

Skills

  • Proficient in Microsoft Applications; Word, Excel and Outlook
  • Proficient of EPIC, IDX, C0-Path, Eagle, Next-Gen and NYS application systems
  • Knowledge of Medical Terminology, ICD-10-CM/ CPT coding and billing
  • Excellent written and communication skills
  • Excellent customer service skills
  • Typing Skills 50-65 WPM
  • Bilingual in English/Spanish

Timeline

Patient Financial Specialist I

Memorial Sloan Kettering Hospital
11.2021 - 10.2024

Senior Patient Care Coordinator

Weill Cornell Medical Center
02.2019 - 11.2021

Physician Referral Specialist

Hospital for Special Surgery, Main Campus
08.2016 - 02.2019

Member Services Coordinator

Lighthouse Guild- Guildnet
03.2008 - 11.2014

Bachelors in Science - Health Services

Monroe College

Associates in Applied Science - Medical Administration

Monroe College

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Maria Gonzalez