Patricia Sandoval
Long Beach,CA
Summary
Business Services Representative with 21 years of expertise in hospital administration and revenue cycle management. Skilled in regulatory compliance, workflow optimization, and financial counseling, with a strong proficiency in insurance verification. Excels in fostering effective communication across departments using Microsoft Teams.
Insurance professional with in-depth experience in verifying insurance coverage and handling patient information to ensure smooth operations. Known for reliability and adaptability in dynamic environments, contributing effectively to team goals. Proficient in utilizing verification systems and maintaining comprehensive records while displaying strong attention to detail and collaborative mindset.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Insurance Verification Specialist
Reagan Street Surgery Center
10.2025 - 12.2025
- Verified Insurance coverage, benefits, which included deductibles, COINS, co-pays and OOP's; via telephone or various insurance payor portals.
- Verified Prior Authorization requirements medical group or healthplan, while also establishing who is at Risk for DOFR.
- Looked for Authorization in SCA/HST system and/or insurance payor portals (e.g. Carelon, Optum, Regal MG, etc)
- Assuring Prior Authorizations matched CPT and ICD-10 codes in patient's chart for upcoming procedures.
- Answered calls in a timely manner.
Insurance Verification Specialist
Long Beach Memorial Medical Center
04.2025 - 08.2025
- Worked with Epic, RTE, OnBase, various insurance portal websites.
- Monitored and managed workques in a timely manner to resolve matters in a timely manner.
- Assuring correct insurance payor is attached to pt's account, identifyng any secondary coverage for COB. Making sure to identify the primary payor.
- Check and verify that approriate Deductible, COINS, Co-Pays, and OOP amounts are applied.
- Generated Estimates. Informed Patients of and collect amount due after explaining their financial responsibility.
- Retrieved authorizations from different insurance portals or from OnBase, assuring accuracy of correct patient, patient DOB and MRN, when uploading to patient's records, to avoid HIPPA violations.
- If no authorizations were found, followed up with Dr's office and/or Insurance payors for Prior Auth requirements. Making sure to document in Epic.
- Used MIcrosoft Teams to communicate with co-workers, including supervisor and offices within Long Beach Memorial.
Business Services Representative
Kaiser Permanente
10.2003 - 01.2025
- Worked with Epic System, Microsoft Teams, insurance payor portals.
- Pre-Registraion. Monitored and managed work ques; checking for add-on cases, cancellations, and assuring patient's coverage is active and to reach to patient's to verify demographics, emergency contacts, ask about Advance Directives, and make patient aware of their financial responsibility. Collect co-pays/deductible over the phone if applicable.
- Registration. Using Epic System, registered patients for their outpatient procedures, verifying accuracy of information in patient's chart, starting with the correct patient info. Collected co-pays/deductibles by following cash handling procedures.
- Arm banding patients according to protocols.
- Collecting and releasing valuables from safe.
- Answering any questions that the patient or family member might have, within my scope of practice.
- Answering calls and responding to Microsoft Teams questions in a timely manner.
- Cash out towards end of shift following Cash Handling procedures and dropping in safe and documenting.
Education
Diploma -
Millikan High School
Long Beach, CA06.1989
Skills
- Knowledge in Epic System (including RTE), Microsoft Teams, Portals for Insurance payors
- Revenue Cycle Operations (generate estimates for services after confirming amounts due for Deductibles, COINS, co-pays, OOP)
- Cash/Credit Card collecting according to cash handling procedures
- HIPAA compliance
- Insurance coverage verification
- Data entry proficiency (assuring it is correct patient, MRN, DOB)
- Eligibility determination
- Attention to detail
- Patient confidentiality
- Communication to appropriate parties to ensure patient satisfaction and avoid delays; resolving matters in a timely manner
- Coverage and authorizations
- Communication and interpersonal skills
Certification
Medical Terminology Certificate
Languages
Spanish (Experienced)
Timeline
Insurance Verification Specialist
Reagan Street Surgery Center
10.2025 - 12.2025
Insurance Verification Specialist
Long Beach Memorial Medical Center
04.2025 - 08.2025
Business Services Representative
Kaiser Permanente
10.2003 - 01.2025
Diploma -
Millikan High School