Nicole Rodriguez
565 KINGSLAND AVENUE
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
22
22
years of professional experience
Work History
Prior Authorization Specialist
61st Street Service Corporation
09.2024 - Current
- Processed prior authorization requests to ensure compliance with regulations and guidelines.
- Collaborated with healthcare providers to gather necessary documentation for approvals.
- Evaluated medical necessity and appropriateness of requested services using established criteria.
- Implemented workflow improvements to increase efficiency in authorization processing.
- Analyzed trends in authorization denials to develop strategies for reducing rejections.
- Facilitated communication between clinical teams and insurance representatives to resolve issues promptly.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
Patient Care Coordinator/Surgical Coordinator
Optum ENT
04.2021 - Current
- Answer incoming calls and scheduled appointments
- Verify patient insurance and enter patient information into EMR (Epic)system.
- Process payments using cash and maintain accurate records of transactions.
- Improve patient experience by efficiently coordinating pre-operative preparations and post-operative follow-up care.
- Communicate with the surgical team by maintaining accurate schedules and promptly addressing any changes or concerns.
- Streamline communication between patients and healthcare providers, ensuring timely responses to inquiries and concerns.
- Manage sensitive patient information with strict adherence to HIPAA guidelines, maintaining confidentiality and privacy at all times.
- Reduce wait times by implementing an effective appointment reminder system for patients, minimizing no-shows and late arrivals.
- Provide exceptional customer service by addressing concerns, answering questions, and ensuring patient satisfaction with their care experience at the clinic.
- Communicate with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures.
- Worked closely with patients to deliver excellent and direct individualized patient care.
- Provide simple, clear explanations to help clients and families understand hospital policies and procedures.
- Contribute to a reduction in surgery cancellations by closely monitoring patient compliance with pre-surgical instructions.
- Provide comprehensive education materials for patients regarding their upcoming surgery, answering questions and alleviating concerns related to the procedure itself or recovery expectations afterward.
- Arrange pre-operative and post-operative appointments for surgical patients.
- Update patient records to reflect upcoming surgeries and medical histories.
- Managed planning, scheduling, and coordination of outpatient procedures.
- Obtain pre-authorizations and pre-certifications ahead of scheduled surgeries.
Administrative Assistant
SportsCare Of America
03.2003 - 04.2021
- Enhance office efficiency by streamlining administrative processes and implementing organizational systems.
- Improve customer satisfaction through prompt and professional handling of inquiries and concerns.
- Support administrative tasks such as filing, data entry, and document preparation for more efficient office workflow.
- Resolve billing discrepancies promptly with thorough attention to detail, fostering trust between clients and the organization.
- Schedule, coordinated and confirmed appointments and meetings.
- Complete data entry and filing to keep records updated for easy retrieval.
- Helped office staff prepare reports and presentations for internal or client-related use.
- Ensure HIPAA compliance by maintaining strict confidentiality with all patient records and information.
- Assists with insurance verification tasks, expediting the billing process for both patients and providers.
- Provide administrative support to medical staff, assisting with various clerical tasks as needed.
- Handle financial transactions related to copayments or self-pay fees while adhering to company policies regarding payment collection.
Education
Bachelor of Science - Business Administration/Marketing
Berkeley College
West Paterson, NJ05-2005
Skills
- Patient Care Coordination
- Insurance Verification
- Administrative and Office Support
- Time management abilities
- Reliability
- Spanish Speaking
- Authorizations
- Effective communication skills
- Data entry
- Electronic health records proficiency
- Medical terminology knowledge
- Physician order verification
- Benefit coverage
- Medical office procedures
- Insurance procedures
- Retro-authorizations
- Patient scheduling
Timeline
Prior Authorization Specialist
61st Street Service Corporation
09.2024 - Current
Patient Care Coordinator/Surgical Coordinator
Optum ENT
04.2021 - Current
Administrative Assistant
SportsCare Of America
03.2003 - 04.2021
Bachelor of Science - Business Administration/Marketing
Berkeley College
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