Michelle Ybarra
Redlands Community Hospital
Colton,CA
29
years of professional experience
Dynamic healthcare professional with expertise in utilization management and claims processing at Redlands Community Hospital. Proven ability to enhance patient engagement through effective communication and problem-solving. Skilled in HIPAA compliance and time management, consistently achieving streamlined processes and improved patient experiences. Committed to delivering high-quality care in fast-paced environments.
Work History
Utilization Management Representative
6 Years 5 Months- Evaluated patient care plans to ensure compliance with utilization management protocols.
- Collaborated with healthcare providers to facilitate timely authorizations and referrals.
- Assisted in reviewing medical documentation for accuracy and completeness in claims processing.
- Communicated with patients regarding benefits, coverage options, and appeals processes.
Financial Counselor
15 Years 1 Month- Provided financial counseling to patients, enhancing understanding of insurance options and payment plans.
- Assisted patients in navigating complex billing processes, ensuring timely resolution of inquiries.
- Developed educational materials on financial assistance programs, improving patient engagement and awareness.
- Collaborated with healthcare teams to facilitate seamless communication regarding patient accounts and financial status.
Patient Access Representative
4 Years- Managed patient registration processes to ensure accurate demographic data collection.
- Facilitated communication between patients and healthcare providers, enhancing service efficiency.
- Streamlined insurance verification procedures to reduce delays in patient care access.
- Trained new staff on patient access protocols and electronic health record systems.
- Ensured compliance with HIPAA regulations to maintain confidentiality of sensitive patient information during all interactions.
- Collaborated with various departments to optimize workflow and improve patient experience.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Adapted quickly to changing demands within the healthcare environment, demonstrating flexibility and a strong commitment to quality patient care.
- Provided excellent customer service through active listening skills, understanding patient needs, and offering tailored solutions where applicable.
Eligibility Representative
3 Years 10 Months- Evaluated patient eligibility for various healthcare programs and services.
- Processed applications efficiently, ensuring compliance with regulatory requirements.
- Assisted patients in understanding benefits and coverage options available to them.
- Coordinated with healthcare providers to resolve eligibility issues promptly.
- Implemented workflow improvements to enhance processing speed and accuracy.
- Reduced errors in eligibility determinations through meticulous attention to detail and rigorous quality control measures.
Education
High School Diploma
Skills
Critical thinking
HIPAA compliance
Professionalism and ethics
Claims processing
Insurance verification
Time management mastery
Problem solving prowess
Healthcare regulations
Resourcefulness and initiative
Goal oriented approach
Utilization review expertise
Teamwork and collaboration
Problem-solving
Time management
Attention to detail
Problem-solving abilities
Multitasking
Multitasking Abilities
Timeline
Utilization Management Representative
Redlands Community Hospital
05.2020 - CurrentRead More
Financial Counselor
Redlands Community Hospital
04.2005 - 05.2020Read More
Patient Access Representative
Redlands Community Hospital
04.2001 - 04.2005Read More
Eligibility Representative
Primecare Medical Group
06.1997 - 04.2001Read More
Colton High School
High School Diploma
Read More