Ofelia Fernandez
Summary
Resourceful Manager highly productive in streamlining operations and completing tasks efficiently. Possess key skills in time management, resource allocation, and workflow optimization, ensuring projects meet deadlines with precision. Excel in communication, problem-solving, and adaptability, leveraging these soft skills to enhance team performance and client satisfaction.
Overview
10
10
years of professional experience
Work History
Authorizations & Scheduling Manager
ASPIRE HOSPITAL
02.2023 - Current
- Manage department authorizations with a result rate of 96% in insurance authorization approvals, utilizing payer portals, Carelon, Cohere, Evicore, Availity, United Healthcare, Tricare, Medicaid, and Evolent, etc.
- Regulated and track authorizations with strong attention to detail, enter data necessary to process claims, document authorization required to maximize the opportunity for reimbursement.
- Counseled department in medical documentation when needed to expedite approval, ensure follow up to the provider and member in a timely manner; prioritize the incoming of authorizations by level of urgency to the patient.
- Maintain good working knowledge of authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records.
- Manage and provide prompt feedback to physicians and management regarding documentation issues, payer issues in order to successfully obtain authorization.
- Work effectively both independently and as part of a team to achieve goals.
- Collaborate with chief executive officer to develop and implement performance goals, objectives and maintain a goal oriented, teamwork environment.
- Coordinated over 1200 monthly appointments for patients across multiple healthcare providers with 100% customer satisfaction rate.
- Streamlined the communication process between patients and medical professionals, improving service quality.
- Implemented a system for arranging callback appointments, achieving satisfaction score of 98% from patients.
- Decreased patient no shows by 85% through a text and email reminder system.
- Mentored five schedulers and improved their performance effectiveness by 50% with time management training.
- Consistently meet monthly goals.
Frontline Representative
EVEREST URGENT CARE
01.2019 - 08.2019
- Verify benefits and eligibility for commercial and government health plans; communicate benefit accumulations with member.
- Review medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims filed.
- Monitor workflow to coordinate the intake, triage, referrals, scheduling and navigation of care for new and established patients.
Clinic Manager
DOCTORS CLINIC HOUSTON
09.2015 - 08.2018
- Managed practice day-to-day operations, including managing staff, patient care, administrative tasks to deliver efficient and high-quality service.
- Facilitated effective communication and cooperation among healthcare teams, resulting in a 25% reduction in communication-related errors.
- Initiated a cross-functional collaboration, contributing to a 20% improvement in patient outcomes.
- Assist physicians in daily clinic operations, demonstrating a strong sense of responsibility and teamwork.
- Managed changing priorities and high stress situations in a fast-paced environment.
- Engaged in ongoing professional development, attending workshops and training sessions to increase team knowledge retention.
- Managed workers compensation, personal injury, and professional referral authorizations.
- Regulated and track authorizations with strong attention to detail, enter data necessary to process claims, document authorization required to maximize the opportunity for reimbursement.
Education
Master - Human Resource Management
University of Phoenix
Houston, TX01.2008
Bachelor of Business Administration -
American InterContinental University
Houston, TX01.2007
Certified Professional Biller Course -
AAPC
Skills
- Payer portal navigation
- Authorizations management
- Project management
- Performance metrics
- Problem solving
- Team supervision
- Critical thinking
- Time management skills
Timeline
Authorizations & Scheduling Manager
ASPIRE HOSPITAL
02.2023 - Current
Frontline Representative
EVEREST URGENT CARE
01.2019 - 08.2019
Clinic Manager
DOCTORS CLINIC HOUSTON
09.2015 - 08.2018
Master - Human Resource Management
University of Phoenix
Bachelor of Business Administration -
American InterContinental University
Certified Professional Biller Course -
AAPC
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