Olga Gallardo
Brentwood,CA
Summary
Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.
Overview
18
18
years of professional experience
1998
1998
years of post-secondary education
Work History
Care Management Associate
Aetna, a CVS Health
Hartford
10.2020 - 04.2025
- Coordinated care plans for members with complex health needs.
- Facilitated communication between patients and healthcare providers.
- Managed case files and updated patient records in electronic systems.
- Assisted members in navigating healthcare resources and services.
- Educated patients on treatment options and preventive health measures.
- Monitored progress of care plans and adjusted as necessary.
- Answered phone calls and responded to questions and concerns.
- Learned new techniques and kept up with technological advancements in industry to add extra value to medical services.
- Implemented strategies for managing complex cases involving multiple providers or services.
- Attended continuing education courses to stay up-to-date on current trends in the field of care management.
- Established positive relationships with patients and their families through frequent contact and follow-up visits.
- Participated in team meetings to discuss case updates, review new referrals and brainstorm solutions for difficult cases.
- Maintained accurate records of all client contacts, including assessment notes, treatment plans and other relevant documents.
Precertification Specialist
Aetna, a CVS Health
Hartford, Connecticut
11.2006 - 10.2020
- Managed precertification requests for various medical services and procedures.
- Reviewed clinical documentation to ensure compliance with insurance guidelines.
- Collaborated with healthcare providers to obtain necessary patient information.
- Utilized Aetna's systems to track and document precertification processes.
- Communicated effectively with patients regarding precertification status and requirements.
- Assisted in training new team members on precertification protocols and procedures.
- Resolved issues related to denied precertifications through thorough investigation and follow-up.
- Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
- Assisted with answering provider inquiries regarding preauthorization requirements and processes.
- Collaborated with other departments within the organization as needed to resolve issues or obtain additional information.
- Compiled and submitted precertification requests for review by payers in accordance with established timelines.
- Reviewed patient medical records to determine medical necessity for requested services and procedures.
- Analyzed trends in denials or rejections of claims due to lack of proper authorization.
- Maintained detailed documentation of all activities related to the precertification process.
- Resolved any discrepancies identified during the precertification process.
- Processed appeals when necessary following denial or rejection of claims due to lack of proper authorization.
- Participated in training sessions conducted by insurers concerning changes in policies, procedures, guidelines.
- Evaluated clinical criteria against existing health plan guidelines to determine authorization status.
- Ensured compliance with all HIPAA regulations pertaining to protected health information.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
Education
Liberty High
Brentwood, CASkills
- Care coordination
- Case management
- Medical documentation
- Electronic records management
- Insurance precertification
- Problem solving
- Discharge planning
- CPT coding
- Patient intake procedures
- Clinical collaboration
Languages
Spanish
Limited
Work Preference
Work Type
Full TimeLocation Preference
RemoteHybridOn-SiteTimeline
Care Management Associate
Aetna, a CVS Health
10.2020 - 04.2025
Precertification Specialist
Aetna, a CVS Health
11.2006 - 10.2020
Liberty High