Monique Hernandez
Pomona,CA
Summary
Seeking employment in a medical establishment as a Medical Biller or Coder, Surgical Coordinator, Prior Authorization Coordinator, Eligibility Specialist, or Grievances & Appeals Coordinator. I pride myself as a determined, detailed, and organized individual. Others would say I am highly-motivated, hardworking, dependable and that i am a fast learner.
Overview
8
8
years of professional experience
Work History
Behavioral Health Utilization Management Rep
Elevance Health (Anthem Blue Cross)
WFH, CA
06.2022 - Current
- Facilitated prompt processing of referrals from providers, streamlining inpatient and outpatient stays and treatments.
- Input hospital authorization for payments and admissions based on health plan benefits for behavioral health and substance abuse patients.
- Provided resourceful information to members regarding the various ways they could access care with their preferred providers.
- Managed fax processing and data entry for authorizations related to treatment and assessment of Autism Spectrum Disorder.
Procedure Coordinator
Elite Cardiology Group
Upland
02.2021 - 04.2022
- Secured authorized payment for surgeries/procedures from medical groups/insurance companies.
- Managed physician's procedure scheduling and coordinated outpatient/inpatient procedures at San Antonio Regional Hospital.
- Provided counseling on instructions and preparation before procedures as well as post-procedure care
- Conducted thorough medication reviews to minimize potential risks of patient mortality.
Patient Coordinator/Liaison
Los Angeles Reproductive Center
Encino
07.2020 - 02.2021
- Verified insurance plan benefits for Infertility/Reproductive Preservation services and conducted claim investigations
- Efficiently organized the scheduling of initial consultations, corrective surgical procedures, and coordination of specimen collection samples
- Maintained up-to-date and precise records of patient treatment performance statistics on a monthly basis
- Acted as a liaison between patients, addressing inquiries and worries about their treatment cycles.
Patient Service Representative
Cedars Sinai Medical Foundation
Beverly Hills
07.2019 - 07.2020
- Handled incoming phone calls, message forwarding, form completion, and letter drafting for patients to submit to school or employer.
- Verified patient coverage and eligibility through online and telephone communication for various insurance plans including PPO, EPO, POS, HMO, Medicare, and Medi-Cal
- Assisted patients in form completion, scanned medical records in patients' charts, and requested medical records.
- Coordinated triage efforts, organized clinical schedule, and scheduled diagnostic procedures for doctor.
Appeals & Grievance Coordinator
TotalMed Staffing | HealthNet
Woodland Hills
02.2019 - 05.2019
- Complied with all DMHC and CDI deadlines and regulations within specified timeframes.
- Conducted investigations and hearings on state fair claims
- Ensured medical records were obtained and forwarded to the clinical team for Referral/Rx Pharmacy denials overturn/upholds
- Provided support to ensure timely retrieval of appointments and effective coordination of care for members per contractual requirements
Prior Authorization Coordinator
Lakeside Community Healthcare
Burbank
12.2016 - 01.2019
- Effectively interpret physicians' recommendations for appropriate diagnostic studies/consultations/DME supplies
- Monitored approval processes and kept patients informed through an Excel sheet for follow up on appeals, denials, pending authorizations
- Proficiently operated office equipment such as voicemail messaging systems while utilizing Microsoft Word, Excel, and other software applications for the preparation of reports, invoices, financial statements, letters and medical records.
- Verified insurance coverage and patient responsibilities by communicating with insurance providers.
Education
High School Diploma -
ArTES Magnet High School
Medical Billing and Coding
San Joaquin Valley College
Visalia, CASkills
- Proficient in navigation of EMR Platforms; Artisan, Epic, NextGen, Practice Fusion, Care Tracker, AUMI
- Leadership skills, conflict resolution techniques, and self-efficient
- Computer Savvy (Microsoft Applications), Pivot tables, Statistics
- Insurance verification knowledge
- Bilingual; English and Spanish, reading, writing and spoken
- Medical billing processing and coding review
Timeline
Behavioral Health Utilization Management Rep
Elevance Health (Anthem Blue Cross)
06.2022 - Current
Procedure Coordinator
Elite Cardiology Group
02.2021 - 04.2022
Patient Coordinator/Liaison
Los Angeles Reproductive Center
07.2020 - 02.2021
Patient Service Representative
Cedars Sinai Medical Foundation
07.2019 - 07.2020
Appeals & Grievance Coordinator
TotalMed Staffing | HealthNet
02.2019 - 05.2019
Prior Authorization Coordinator
Lakeside Community Healthcare
12.2016 - 01.2019
High School Diploma -
ArTES Magnet High School
Medical Billing and Coding
San Joaquin Valley College