Michael Morales
Summary
As a versatile professional, I hold the dual roles of Medical Administrative Assistant and Project Manager, with a specialized focus in the medical industry, although my expertise extends beyond that domain. In my capacity as a Medical Administrative Assistant, I am dedicated to cultivating positive and constructive relationships with our valued customers. This approach not only ensures the utmost medical safety and well-being of our patients but also contributes to the overall growth and success of our business. By fostering open communication, providing personalized attention, and demonstrating a deep understanding of our clients' unique needs, I am able to effectively coordinate and manage various administrative and project-related tasks within and out the medical field. This multifaceted role allows me to leverage my strong organizational skills, attention to detail, and problem-solving abilities to deliver exceptional service and support to our customers, ultimately contributing to the continued advancement and expansion of our operations.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Administrative Assistant Authorizations/biller
VRM Consultants
New York
04.2022 - Current
- Scheduled meetings and recorded minutes for interoffice distribution
- Processed correspondence, documents and reports to support clerical staff
- Created dynamic spreadsheets using knowledge of Microsoft Excel formulas
- Worked on special projects, taking lead on important project initiatives
- Prioritized workflow and resolved daily operational challenges to support goal achievement
- Drafted accurate and grammatically correct medical necessity and coding appeals
- Inquired with physicians to clarify ambiguous codes
- Observed and enforced all ICD-10-CM coding rules and regulations
- Managed coding and abstracting of inpatient and outpatient medical records
- Documented each patient's condition and treatment in their permanent medical records
- Maintained well-organized and efficient medical records system, quickly filing and retrieving files for clinical team members
- Explained charges to patients and assisted with resolving discrepancies
- Collected required information from medical units to prepare bills
- Reviewed clinical statements and assigned standard codes using CPT, ICD-10-CM, or HCPCS Level II
- Quickly processed incoming payments and posted to the correct account
- Assisted physicians and clinicians with examinations, procedures and vital signs monitoring
- Maintained billing files, payments received and pending payment files
- Cross-checked and verified accuracy of invoices and requisition forms before sharing with clients
- Generated and shared reports with management on pending payments, accounting and statements involving weekly aging reports and month-end closing reports.
- Resolved discrepancies between payroll records and employee inquiries.
- Tracked vacation accruals and sick leave balances for all employees.
Clinical Manager
Magellan RX
05.2020 - 04.2022
- Evaluate and authorize approval of prior authorization pharmacy requests from prescriber
- Determines appropriateness for medications
- Communicate decisions to physicians, physicians office staff, medical management staff or any other Communicate select prior authorization criteria, pharmacy benefit coverage and formulary alternatives to the physicians
- Escalate requests to Pharmacists when request requires extensive clinical review or denial
- Resolved customer issues and answered questions to deliver positive customer experience
- Calculated doses and volumes based on pharmaceutical notes.
Inventory Specialist Pharmacy Tech
CVS Pharmacy
01.2015 - 08.2021
- Operate office equipment, such as fax machines, copiers, or phone systems and arrange for repairs when equipment malfunctions
- Create, maintain, and enter information into databases
- Answer telephones and give information to callers, take messages, or transfer calls to appropriate individuals
- Use computers for various applications, such as database management or word processing
- Receive written prescription or refill requests and verify that information is complete and accurate
- Prepare and process medical insurance claim forms and records
- Receive and store incoming supplies, verify quantities against invoices, check for outdated medications in current inventory, and inform supervisors of stock needs and shortages
- Order, label, and count stock of medications, chemicals, or supplies and enter inventory data into the computer
- Conducted regular cycle counts to contribute to successful inventory management
- Tracked inventory returns, shipping issues and shortages and leveraged data to optimize inventory management
- Recorded product issues and return transactions using electronic product tracking databases.
Education
HIGH SCHOOL DIPLOMA - HIGH SCHOOL
Colegio Para Adultos
BACHELOR OF SCIENCE - ACCOUNTING
Dewey University
M.B.A. - Double Major in Healthcare Administration & Human Resources
National University
Florida City, FLSkills
- Active listening
- Computer and Electronics
- Critical Thinking
- Judgment and Decision Making
- Billing procedures
- Insurance procedures
- Records maintenance
- Data entry
- Private insurance
- Medical terminology
- Assistance authorization
- Teamwork
- Customer and Personal Service
- Negotiation
- Project implementation
- Accounts payable
- Microsoft Office
- Bookkeeping
- QuickBooks
- Executive administrative support
- Google Suite
- Organizational skills
- Project management
- Human resources
Certification
- Pharmacy Technician License
- Medical Coding Certification
- Medical Billing Certification
- Certified Project Manager PMI Certification
Personal Information
Work Permit: Authorized to work in the US for any employer
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
Timeline
Administrative Assistant Authorizations/biller
VRM Consultants
04.2022 - Current
Clinical Manager
Magellan RX
05.2020 - 04.2022
Inventory Specialist Pharmacy Tech
CVS Pharmacy
01.2015 - 08.2021
HIGH SCHOOL DIPLOMA - HIGH SCHOOL
Colegio Para Adultos
BACHELOR OF SCIENCE - ACCOUNTING
Dewey University
M.B.A. - Double Major in Healthcare Administration & Human Resources
National University
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