NICOLE PEDRO
Tracy,CA
Summary
A well-rounded professional with a proven track record on highly successful teams. Over fourteen years of progressively increasing administrative and client management responsibilities in the healthcare, real estate, financial services, and retail sectors. Companies include Valley Care Health Systems, Community Care Property Management, Providian Financial and Bath and Body Works. Goal-oriented employee with vast experience working through dramatic change and process improvement.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Referrals Coordinator
Stanford Valley Care
Pleasanton
06.2015 - Current
- Obtain authorizations on all necessary specialty services for each physician assigned
- Work closely with clinic support staff to facilitate timely authorizations
- Communicate as needed with physicians, and Medical assistants, to prioritize requesting according to authorization, stat, urgent, routine, etc
- Reviewing pending file daily and follow up appropriately with MA, Physicians
- Document appropriately thoroughly in chart
- Contact review organizations and insurance companies to ensure prior approval requirements are met
- Present necessary medical information such as history, diagnosis and prognosis
- Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians
- Ensure that referrals are addressed in a timely manner.
Medical Assistant
ValleyCare Medical Foundation
Pleasanton
04.2013 - 06.2015
- Provides lead front office support for multiple clinic sites- Cardiology, General Surgery, Infectious Disease, Gastroenterology, Pediatrics and Internal Medicine
- Evaluated and re-designed current clinic front office workflows to improve physician performance
- Improved efficiencies allowed for growth of practice to include three additional multispecialty physicians
- Successfully submits inpatient hospital billing for Internal Medicine physicians
- Implemented auditing protocols for Internal Medicine, Cardiology, General Surgery, and Infectious Disease to reduce error rate in billing
- Manages multiple physician schedules in multiple practice locations through enterprise wide NextGen practice management system
- Manages multi line telephone system including multiple voicemails
- Provides timely follow up for all calls
- Vast experience in front office protocols including, registration, appointment scheduling, insurance verification, payment collections and billing
- Supports backoffice protocols including capturing patient information for meaningful use measures, obtaining prior authorizations, medication refill requests and verifications with pharmacies, and patient notification of test results
- Support Internal Medicine physicians with high touch patient outreach to target non-compliant patients
- Manages third part pharmacy and other medical vendor relationships for Internal Medicine practice
- Manage data maintenance and transport of patient records to secured storage
- Handle patient disputes and problems to support physicians.
Education
Tracy High School
Tracy, CA01.1994
Some College (No Degree) - Self Development, Pubic Speaking, Problem Solving
Dale Carnegie of San Joaquin
ModestoSkills
- Caseload Management
- Multi-line phone proficiency
- Insurance precertification processes
- Appointment Scheduling
- Accurate Documentation
- Knowledge in many Specialties (GI, Internal Medicinel, Indocrenology, Pulminary Sleep, Cardioogy, OB/GYN and more)
- Medication Authorization Processing
- Peer to Peer Processing
- Opening New Practices, with Onboarding New Clinicians
- Front office and Back Office Expertise
- Appeals
- Clinical Approvals
- Medical terminology knowledge
- Referral tracking
- Outbound calls
- Insurance Verification
- Multitasking
- Epic System Expertise
- Instant Messaging Expertise
- Cross-Department Communication
- Analytical Problem Solving
- Proficient Time Organization
- Mentoring Others
- Professional Training
- Continuing Education
- Collaborative Problem Solving
- Good Listener and Fun to Work With
Certification
- Self Development Problem Solving Certification
References
References available upon request.
Timeline
Referrals Coordinator
Stanford Valley Care
06.2015 - Current
Medical Assistant
ValleyCare Medical Foundation
04.2013 - 06.2015
Tracy High School
Some College (No Degree) - Self Development, Pubic Speaking, Problem Solving
Dale Carnegie of San Joaquin
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