MILBETH MAESTRE
Fort Stewart,GA
Summary
Professional with robust experience in healthcare coordination and patient support. Adept at streamlining referral processes, ensuring compliance, and enhancing patient care. Strong focus on collaboration, problem-solving, and adapting to changing priorities. Skilled in medical terminology, insurance verification, and electronic health records management. Reliable team player committed to achieving optimal outcomes.
Overview
17
17
years of professional experience
Work History
Medical Referral Specialist and Record Managment
TriWest Healthcare Alliance
03.2025 - Current
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
- Streamlined referral processes for increased efficiency, resulting in timely appointments for patients.
- Verified insurance benefits and eligibility for [Type] procedures before referring clients.
- Promoted clear communication between primary care providers and specialists through detailed documentation and follow-up calls.
- Coordinated with medical staff and patients to find cost-effective options for services.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Managed high-volume referral requests by prioritizing tasks and maintaining organized records.
- Enhanced patient satisfaction by promptly addressing inquiries and resolving issues related to referrals.
- Obtained prior authorization for [Type] procedures.
Pre-Certification Specialist
Intagrated Pain Associates
09.2023 - 01.2025
- Provided excellent customer service by responding promptly to inquiries from members and providers regarding pre-certifications.
- Successfully collaborated with providers to obtain authorization for treatments and procedures.
- Assessed insurance policy terms to determine patient coverage and limitations.
- Utilized exceptional customer service skills to effectively communicate with insurance companies, providers, and patients regarding benefit information.
- Reviewed patient deductibles and copays and entered into billing system.
- Verified insurance coverage and eligibility prior to appointments and procedures.
- Followed established verification processes to confirm insurance benefits, medical necessity, and authorization.
- Addressed and resolved issues identified by billing staff related to eligibility and coverage.
- Processed pre-certification requests by gathering and reviewing necessary patient information for timely approvals.
- Collaborated with clinical staff to ensure accurate and complete clinical documentation for pre-certification submissions.
Team Leader Returns
PepsiCo
03.2017 - 08.2021
- Supervised team members to confirm compliance with set procedures and quality requirements
- Collected, arranged, and input information into database system
- Maintained database systems to track and analyze operational data
- Developed and updated tracking spreadsheets for process monitoring and reporting
- Assisted in recruitment of new team members, hiring
Medical Secretary
Dr Guillermo Faget Oliver
04.2009 - 11.2016
- Managed patient appointments and schedules in a fast-paced medical office setting
- Performed administrative tasks such as answering phones, filing, and data entry
- Handled confidential patient information in compliance with HIPAA regulations
- Assisted healthcare providers with patient exams, procedures, and documentation
- Coordinated referrals and communicated with insurance companies to process claims
- Maintained inventory of office and medical supplies to ensure smooth operations
- Collaborated with other medical staff to provide high-quality patient care
- Demonstrated excellent communication and organizational skills in a medical office environment
- Typing medical documents into the computer (e.g., doctor's dictates and medical records)
- Collaborate with insurance companies to process claims
- Process invoices and payments
- Audit of medical records
- Medical office administration
- Billing and Documentation on Mental Health
- Medical Audit
- Medical Billing and Coding
- Medical Intermediate Coder
- Patient Care Coordination and Education
- Medical Law and Ethics
- Medical Administrative Assistant
- Comprehensive Electronic Health Records
- Externship Readiness Skills
- HIPAA Workforce Proficiency (CHWP)
Education
Certificate -
Limitless Educational Institute
PR07.2024
Associate of Science - undefined
UPR Rio Piedras
PR01.2023
Medical Assistant - undefined
Career Step
01.2022
Medical Billing and Coding - undefined
ICPR Junior College
PR05.2009
Skills
- Customer service
- Database Systems
- Teamwork
- X windows
- Empathy
- Problem-solving
- Communication
- Time management
- Attention to detail
- Adaptability
- Medical terminology
- HIPAA compliance awareness
- Professionalism and ethics
- Healthcare regulations
- Insurance verification expertise
- Patient confidentiality adherence
- Referral coordination
- Electronic health records management
- Prior authorization
- Medical terminology proficiency
- Documentation and paperwork
- Microsoft office
- Data entry
- Appointment scheduling
- Knowledgeable in [software]
- Eligibility procedures
- Teamwork and collaboration
- Multitasking Abilities
- Problem-solving abilities
- Multitasking
- HIPAA compliance
- Adaptability and flexibility
- Insurance verification
- Pre-authorizations
LANGUAGES
Spanish Native
English Bilingual
Timeline
Medical Referral Specialist and Record Managment
TriWest Healthcare Alliance
03.2025 - Current
Pre-Certification Specialist
Intagrated Pain Associates
09.2023 - 01.2025
Team Leader Returns
PepsiCo
03.2017 - 08.2021
Medical Secretary
Dr Guillermo Faget Oliver
04.2009 - 11.2016
Associate of Science - undefined
UPR Rio Piedras
Medical Assistant - undefined
Career Step
Medical Billing and Coding - undefined
ICPR Junior College
Certificate -
Limitless Educational Institute