Mayra Amaya
Houston,TX
Summary
Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows.
Overview
6
6
years of professional experience
Work History
Revenue Cycle Specialist
TX, Houston Methodist
Houston, Tx
03.2021 - Current
- Contributes to patient, employee and physician satisfaction
- Assures accounts are secure by reviewing and documenting benefits, patient responsibilities, authorizations / pre-certifications
- Initiate authorizations for surgeries and utilizing clinicals provided by physician
- Collected payments for upcoming surgeries
- Monitor and track authorizations, assure CPT codes, location and CPT codes match authorization
- Verify benefits and eligibility including limitations and exclusions timely and accurately
- Review claims and prepare for submission
- Input all patient data regarding claims and prior authorizations into system accurately.
- Created and maintained spreadsheets detailing medical procedures and insurance denials and approvals.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
ACM Patient Access Center Representative
Houston Methodist
Houston, Tx
11.2019 - 03.2021
- Efficiently completed registration by obtaining patient demographics, insurance information, guarantor information
- Obtained authorization with insurance companies if needed
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
Intake Specialist
McKesson, Intrafusion
Houston, TX
12.2017 - 11.2019
- Initiated pre-determination, precertification, and authorizations as needed
- Worked with clinical and operations teams to facilitate client placement and obtain appropriate services for clients.
- Collected, verified, recorded and processed client demographics, insurance payments and referral information.
- Reviewed claims and prepare for reimbursement
- Developed and maintained courteous and effective working relationships.
- Offered compassionate and attentive guidance to patients during moments of crisis and trauma.
- Entered referrals into appropriate system based on type of referral obtained.
Account Manager/Team Lead
Altus Infusion
Pearland, TX
08.2016 - 12.2017
- Responsible for training new account managers and retraining for existing accounts
- Performed various audits of team members to ensure quality and production metrics were met
- Managed all communications between doctor's office, patient and corporate office
- Obtained authorizations, referrals, pre-determinations and pre-certifications as required by patients’ plan
- Was first point of reference for team member questions and escalated issue resolution.
Education
High School Diploma -
Sharpstown High School
Houston, TX05.2000
Skills
- Proficiency in Microsoft Office (Word, Outlook, Epic, Microsoft Teams
- Knowledge of CPT, ICD-9 and ICD-10
- Team Building
- Decision-Making
- Flexible and Adaptable
- Active Listening
- Multitasking Abilities
- Excellent Communication
- Self-Motivated
- Review of clinical documentation
- Efficient communicator
- Knowledge of HMO’s, Medicare and Medicaid
- Insurance Verification
Languages
Bilingual: English / Spanish
Timeline
Revenue Cycle Specialist
TX, Houston Methodist
03.2021 - Current
ACM Patient Access Center Representative
Houston Methodist
11.2019 - 03.2021
Intake Specialist
McKesson, Intrafusion
12.2017 - 11.2019
Account Manager/Team Lead
Altus Infusion
08.2016 - 12.2017
High School Diploma -
Sharpstown High School