Michelle Navarrete
Orlando,FL
Summary
With over two decades at the forefront of medical management, including pivotal roles at Anthem BCBS, I excel in bilingual communication and navigating complex healthcare systems. Renowned for adeptly coordinating surgical procedures and enhancing patient care through meticulous authorization processes, my expertise in EMR systems and exceptional multitasking abilities stand out, driving significant operational efficiencies.
Overview
20
20
years of professional experience
Work History
Medical Management Specialist
Anthem BCBS
Orlando, FL
09.2021 - Current
- Sort through Inpatient workbasket. Verify HIPPA. Read through hospital Facesheets if facility is out of network create authorizations for Observation stay. Assign appropriate CPT and ICD-10 codes based of clinical information provided. Create Inpatient authorizations and assign to corresponding nurse.
- Contact members to notify them of STAT approvals/denials.
- Assist in Post-MDR process to review CPT codes, ICD-10 codes match attached clinicals, and review MD's criteria for accuracy.
- Create extensions on authorizations missing necessary clinical information.
- Review and assign cases from Inpatient hospital census.
- Translate rationales for denial letters for Spanish speaking members.
Surgical Coordinator
South Miami Gynecologic Oncology Group
Miami, FL
12.2009 - 09.2021
- Schedule and manage surgical schedule for several GYN/Oncologists.
- Obtain surgical authorizations in advance to assure no delay for preset surgery date. Review/provide clinicals with nurses when auth was sent for review. Schedule Peer to Peer reviews with physician when authorization was denied.
- Review surgical benefits with patients and collect deductible/ co-insurance based on CPT code(s) and patients insurance benefits.
- Review medical history and obtain necessary medical clearance for patient prior to surgical date.
- Enter surgeries into EMR system for physicians to bill.
- Calling hospitals to post same day admissions for surgery.
- Coordinate with other specialist offices for dual surgery cases.
- Order any special surgical equipment needed including C02 lasers, Myosure, etc.
- Act as lead when office supervisor was out of the office assisting staff, patient complaints etc.
Breast Biopsy Coordinator
Diagnostic Center For Women
Miami, FL
08.2004 - 12.2009
- Scheduled patient for breast biopsies.
- Ordered and scheduled patients for pre operative testing and or clearances if needed.
- Prepped charts for procedure day with mammogram films, ultrasound images, requested/obtained prior imaging from other centers.
- Scheduled post operative appointments.
- Faxed medical records when referred to oncologist or for second opinions.
- Printed copy of images (films/CD's) when requested.
Education
High School Diploma -
Felix Varela Senior High School
Miami, FL06-2007
Skills
- Bilingual fluent in both English and Spanish
- Twenty years of medical experience, medical terminology including ICD-10 codes, and CPT codes
- Skilled use with several EMR systems
- Multi tasking and time management
- Proficient with Microsoft Word, Excel, Outlook, and Power Point
References
References available upon request.
Timeline
Medical Management Specialist
Anthem BCBS
09.2021 - Current
Surgical Coordinator
South Miami Gynecologic Oncology Group
12.2009 - 09.2021
Breast Biopsy Coordinator
Diagnostic Center For Women
08.2004 - 12.2009
High School Diploma -
Felix Varela Senior High School