Marlene Rodriguez
Fullerton,CA
Summary
Dynamic professional with a proven track record at PhyNet Dermatology, excelling in prior authorizations with a 95% approval rate. Expert in EMR systems and HIPAA compliance, coupled with exceptional team collaboration skills. Demonstrated ability to enhance patient satisfaction and streamline healthcare processes through effective communication and clinical workflow analysis.
Overview
4
4
years of professional experience
Work History
PhyNet Dermatology
Prior Authorizations Specialist
07.2024 - Current
- Processed an average of 100 prior authorization requests daily, achieving a 95% approval rate by utilizing comprehensive knowledge of insurance guidelines and implementing effective verification procedures.
- Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
Coury & Buehler Physical Therapy
Insurance Verification Representative
05.2023 - 07.2024
- Assured timely verification of insurance benefits prior to patient procedures or appointments averaging 150 patients weekly.
- Reduced claim denials by thoroughly reviewing patient eligibility and coverage details.
- Resolved discrepancies in insurance claims by efficiently communicating with patients and carriers.
- Contributed to company growth by consistently meeting performance metrics for speed, accuracy, and client satisfaction in the insurance verification process.
The Walt Disney Company
Security Hostess
10.2021 - 07.2024
- Responded quickly to emergency situations to assess and deflect issues.
- Remained calm, assertive, and mindful to think critically and problem solve during stressful situations.
- Prevented crimes by immediately reporting all unusual, unauthorized and illegal activity on premises.
- Actively participated in regular meetings with upper management to discuss ongoing security issues, trends, and potential risks facing the company.
Intake Specialist
Pacific Medical Management Services
11.2020 - 05.2021
- Reduced errors in documentation through diligent proofreading before submission, maintaining high standards of quality control throughout the entire intake process.
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
- Increased customer satisfaction with timely follow-ups, ensuring all necessary documentation was collected and processed promptly.
- Collaborated with other departments to streamline workflow processes, resulting in increased efficiency and a more cohesive organizational structure.
Education
Bachelor of Science - Health Science
California State University of Dominguez Hills
Carson, CA05-2022
Associate of Arts - Business Communications Office Technology
Cerritos College
Norwalk, CA05-2015
Skills
- EMR Systems
- EMR Software
- Clinical Workflow Analysis
- HIPAA Compliance
- Clinical Documentation
- Healthcare Analytics
- Medical coding familiarity
- ICD-10 Knowledge
- Medical insurance
- CRM Software
- Complaint Handling
- Team Collaboration
Languages
Spanish
Native or Bilingual
Work Preference
Work Type
Full TimeWork Location
RemoteHybridOn-SiteImportant To Me
Work-life balanceCompany Culture401k matchPaid sick leave4-day work weekCareer advancementFlexible work hoursPaid time offWork from home optionHealthcare benefitsPersonal development programsStock Options / Equity / Profit SharingSoftware
ECW
EMA
Raintree
Laserfiche
Clinicient
Epic
Interests
Health Science
Timeline
PhyNet Dermatology
Prior Authorizations Specialist
07.2024 - Current
Coury & Buehler Physical Therapy
Insurance Verification Representative
05.2023 - 07.2024
The Walt Disney Company
Security Hostess
10.2021 - 07.2024
Intake Specialist
Pacific Medical Management Services
11.2020 - 05.2021
Bachelor of Science - Health Science
California State University of Dominguez Hills
Associate of Arts - Business Communications Office Technology
Cerritos College
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