Marlen Arreguin
Las Vegas ,NV
Summary
Adept at streamlining prior authorization processes, I enhanced patient satisfaction and surgery scheduling accuracy at Red Rock Neurology & Pain Management. My expertise in ICD-10 coding and exceptional communication skills led to a significant improvement in operational efficiency. Maintaining HIPAA compliance, I successfully managed high-volume tasks, demonstrating a strong blend of technical knowledge and interpersonal abilities.
Overview
4
4
years of professional experience
Work History
Prior Authorization Specialist
Red Rock Neurology & Pain Managment
2024.05 - 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.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
- Improved accuracy in surgery scheduling, ensuring appropriate pre-operative preparations were completed.
- Coordinated complex surgical cases, including multi-disciplinary surgeries, to optimize patient outcomes.
- Maintained accurate records of all scheduled procedures, contributing to seamless hospital operations.
- Reduced patient wait times with effective communication between surgeons, staff, and patients.
- Verified insurance coverage and obtained pre-authorizations.
Surgery Scheduler
Red Rock Surgery Center
2022.04 - 2024.04
- Educated patients on pre-surgery requirements, such as fasting protocols or medication adjustments, resulting in fewer complications on the day of the procedure.
- Handled urgent requests effectively, prioritizing cases requiring immediate attention while also balancing routine surgery demands appropriately.
- Arranged pre-operative and post-operative appointments for surgical patients.
- Expertly managed planning, scheduling, and coordination of outpatient procedures.
- Verified insurance coverage and obtained pre-authorizations.
- Maintained strict confidentiality in handling sensitive patient information, adhering to HIPAA guidelines and clinic policies.
- Obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
- Resolved scheduling conflicts to maintain high-quality patient services.
- Checked patients in and out and collected payments.
- Educated patients about surgeries and provided treatment plan documentation.
- Collated pre-operative lab and imaging results to facilitate surgery planning.
- Managed office bookkeeping with insurance billing and patient payments.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
- Processed medical insurance claims and payments.
Packer Operator
DHL Express
2020.09 - 2022.02
- Maintained a clean and safe work environment by adhering to company safety protocols and regulations.
- Enhanced product quality by closely monitoring packing procedures and addressing any issues promptly.
- Managed multiple tasks simultaneously while maintaining accuracy during high-volume periods.
- Maintained excellent attendance record throughout tenure at the position.
- Reduced waste materials through careful planning of packing strategies and efficient use of resources.
- Streamlined packaging operations for faster turnaround times, resulting in higher productivity levels.
- Increased efficiency in packing process by implementing new equipment and techniques.
- Consistently met deadlines for order fulfillment, contributing to overall company success in meeting customer expectations.
- Resolved technical issues with machinery promptly, minimizing downtime and potential disruptions to production timelines.
- Collaborated with team members to achieve daily goals and meet company objectives.
Education
High School Diploma -
Desert Pines High School
Las Vegas, NV05.2019
Skills
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Terminology
- Medical Appeals Handling
- Authorizations
- Insurance Verification
- Effective communication skills
- Patient Referrals
- Medicare and Medicaid knowledge
- Data Entry
- HIPAA Compliance Knowledge
- CPT coding knowledge
- Electronic Health Records Proficiency
- Medical terminology knowledge
- Physician order verification
- Understanding of medical terms
- Benefit Coverage
- Medical Office Procedures
- Insurance procedures
- Understanding of insurance details
- Billing Procedures
- Process improvement strategies
- Professionalism and Ethics
- Patient Confidentiality Compliance
- Patient Scheduling
- Provider Relations
- Medical Coding
- Multitasking
- Problem-Solving
- Telephone Etiquette
- Appointment Scheduling
Languages
English
Professional Working
Spanish
Native or Bilingual
Timeline
Prior Authorization Specialist
Red Rock Neurology & Pain Managment
2024.05 - Current
Surgery Scheduler
Red Rock Surgery Center
2022.04 - 2024.04
Packer Operator
DHL Express
2020.09 - 2022.02
High School Diploma -
Desert Pines High School
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