Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Maria Lopez

Sylmar,CA

Summary

Dynamic Prior Authorization Specialist with a proven track record at Alta Orthopaedics, excelling in the prior authorization process and effective communication. Achieved a high success rate in obtaining authorizations through meticulous documentation and strong interpersonal skills, enhancing patient satisfaction and streamlining workflows in a fast-paced environment.

Healthcare professional prepared for role with strong background in managing prior authorizations and fostering positive relationships with healthcare providers and insurance companies. Known for collaborative approach and consistently achieving results despite changing needs. Proficient in medical coding, insurance guidelines, and effective communication.

Experienced with navigating healthcare insurance systems to secure treatment approvals. Utilizes keen attention to detail and extensive knowledge of medical coding to streamline processes. Strong understanding of insurance guidelines and patient advocacy to ensure optimal outcomes.

Professional administrative specialist prepared for role requiring exceptional organizational and interpersonal skills. Background includes managing high-traffic reception areas, coordinating schedules, and providing top-notch customer service. Known for strong teamwork and adaptability, ensuring seamless operations and positive client interactions.

Professional in healthcare administration with strong background in managing authorization processes. Adept at ensuring compliance, streamlining workflows, and mitigating risks. Consistent track record of fostering team collaboration and achieving results in dynamic environments. Skilled in navigating complex systems, prioritizing tasks, and maintaining high standards of accuracy and efficiency.

Overview

5
5
years of professional experience

Work History

Prior Authorization Specialist

Alta Orthopaedics
03.2022 - Current
  • Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
  • Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
  • Analyzed medical records and other documents to determine approval of requests for authorization.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Responded to inquiries from healthcare providers regarding prior authorization requests.
  • Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
  • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
  • Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
  • Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
  • Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
  • Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
  • Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
  • Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
  • Developed and maintained productive working relationships with healthcare providers.
  • Maintained up-to-date knowledge of changing healthcare regulations and insurance policies to ensure accurate processing of requests.

Front Desk Receptionist

California Dermatology Group
01.2022 - 03.2022
  • Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
  • Maintained organized and clean front office area to create professional and welcoming environment for visitors and employees.
  • Scheduled, coordinated and confirmed appointments and meetings.
  • Delivered outstanding first impressions by warmly greeting visitors upon arrival at the front desk.
  • Have efficient knowledge of MOHLS surgery and be knowledagble of healing/surgery procedures
  • Collected room deposits, fees, and payments.
  • Supported administrative tasks such as filing, data entry, and document preparation for more efficient office workflow.
  • Expedited check-in and check-out procedures for guests, ensuring seamless experiences during their visits.
  • Enhanced customer satisfaction by providing efficient and professional front desk services.
  • Handled sensitive customer information with confidentiality, adhering to company privacy guidelines.

Front Desk Receptionist

Jackson Medical Group
02.2021 - 12.2021
  • Managed high-volume phone calls, directing inquiries to appropriate personnel for prompt resolution.
  • Scheduled appointments accurately using reservation software, reducing conflicts or doublebookings.
  • Developed strong working relationships with team members, fostering a positive work environment.
  • Resolved customer issues quickly and notified supervisor immediately when problems escalated.
  • Contributed to team effort by accomplishing related results as needed, fostering collaborative work environment.
  • Provided information and assistance to visitors and clients, addressing inquiries and resolving issues promptly.
  • Routed incoming mail and messages to relevant personnel without delay.
  • Enhanced customer satisfaction by providing efficient and professional front desk services.
  • Handled assignments independently with good judgement and critical thinking skills.

Education

Advanced Placement - Psychology, Spanish, Calculus

Triumph Charter High School
Sylmar, CA
06-2018

Skills

  • Prior authorization process
  • Medical terminology
  • Medical appeals handling
  • Insurance verification
  • Effective communication skills
  • Data entry
  • Patient referrals
  • Electronic health records proficiency
  • Retro-authorizations
  • Medical coding
  • ICD-10 coding
  • CPT coding
  • Multitasking
  • Telephone etiquette
  • Documentation and paperwork
  • Schedule management
  • Teamwork and collaboration
  • Attention to detail
  • Reliability
  • Adaptability and flexibility
  • Task prioritization
  • Self motivation
  • Interpersonal skills
  • Continuous improvement
  • Time management abilities
  • Adaptability

Languages

Spanish
Native or Bilingual
English
Native or Bilingual

Timeline

Prior Authorization Specialist

Alta Orthopaedics
03.2022 - Current

Front Desk Receptionist

California Dermatology Group
01.2022 - 03.2022

Front Desk Receptionist

Jackson Medical Group
02.2021 - 12.2021

Advanced Placement - Psychology, Spanish, Calculus

Triumph Charter High School
Maria Lopez