Patricia Moore Martinez
Summary
Efficient Prior Authorization Specialist known for high productivity and ability to complete tasks swiftly. Possess specialized skills in insurance verification, medical coding (ICD-10 and CPT), and regulatory compliance. Excel at communication, problem-solving, and time management, ensuring smooth operation within healthcare settings.
Overview
29
29
years of professional experience
Work History
Patient Resolution Specialist
HBCS/Med-Metrix
04.2024 - Current
- Point of contact for patients addressing patient concerns about medical bills and insurance.
- Investigated claims for accuracy.
- Followed up with payers, and worked to resolve outstanding balances.
- Updated and maintained databases with current information.
- Identified needs of customers promptly and efficiently.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Assisted with customer requests and answered questions to improve satisfaction.
Team lead Medicare Member Line/Utilization Management Coordinator 2
Humana
03.2019 - 09.2023
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Provided customer service to patients and healthcare providers, answering questions related to prior authorization and insurance coverage.
- Input prior authorization, and other important medical data into system.
- Coordinated with healthcare providers to gather necessary patient information for prior authorization requests.
- Provided guidance to providers regarding the prior authorization process.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Promoted to leadership position in recognition of strong work ethic and provided exceptional customer service.
- Motivated and empowered team members to build customer satisfaction and loyalty to support retention and growth.
- Offered training and support to keep team members motivated and working toward objectives.
- Identified opportunities for process improvements, implementing changes when required.
- Ensured team adherence to company policies and procedures.
- Created reports summarizing utilization trends, outcomes of reviews and other data as required.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
Account Executive/Service Representative
Clinical Pathology Laboratory
09.2013 - 01.2019
- Maintained assessments of existing accounts; up sell tracking, attrition, and territory
- Retained 300 provider accounts
- Ensured proper documentation and materials are accurately complete for electronic medical records
- Collaborated with management, supervisors, external employees, and clients to resolve and prevent future concerns and issues
Physician Liaison/Marketing Manager
Magic Valley health Services, Inc.
11.2004 - 09.2009
- Maintained and Increased census
- Trained and supervised new liaison hires
- Called on existing and potential referral sources
- Responsible for calling and developing relationships with potential referral sources
- Made outbound calls to engage members and/or providers to verify clinical information/discharge date and admission status for admission
- Documented calls and attach clinical information received for admitting RN
- Worked collaboratively with managers on creation of various marketing tools, ex: brochures, advertisements
- Helped develop, implement, and evaluate marketing plans and tools
- Performed community activities promoting home health and wellness
Front Office Manager
Lindale Medical Laboratory
01.1996 - 06.2004
- Trained, supervised, and assisted the receptionists in their performance of a variety of administrative and public relations and client education duties
- Managed billing clerks in their performance in submissions, ICD coding, CPT coding, submissions, appeals, and updates on state and federal guidelines
- Provided guidance and direction to subordinates, including setting performance standards and monitoring performance
- Conducted timely performance evaluations, mediate interpersonal problems, and address patient/client concerns and issues
- Developed employee schedules, Review front desk operations for efficiency and accuracy
- Managed of office supplies, forms, and reorders
Education
BACHELOR OF SCIENCE - Technical Management
DeVry University
Associates of Arts - general studies
University of Texas at Brownsville
Skills
- Interpersonal skills
- Organization skills
- Time management
- Independent work
- Team collaboration
- Insurance verification
- Patient documentation
- Data analysis
- Conflict resolution
- Customer service
- Process improvement
- Team leadership
- Effective communication
- Interdepartmental collaboration
- Training and supervision
- Customer relationship management
- De-escalation techniques
- Assertiveness
- Confidentiality maintenance
- Dispute analysis
- Professional demeanor
- Procedural Rules Understanding
- Independent Decision-making
- Teamwork and collaboration
- Analytical skills
- Problem-solving aptitude
- Problem sensitivity
- Emotional intelligence
Languages
Spanish
Professional
Timeline
Patient Resolution Specialist
HBCS/Med-Metrix
04.2024 - Current
Team lead Medicare Member Line/Utilization Management Coordinator 2
Humana
03.2019 - 09.2023
Account Executive/Service Representative
Clinical Pathology Laboratory
09.2013 - 01.2019
Physician Liaison/Marketing Manager
Magic Valley health Services, Inc.
11.2004 - 09.2009
Front Office Manager
Lindale Medical Laboratory
01.1996 - 06.2004
BACHELOR OF SCIENCE - Technical Management
DeVry University
Associates of Arts - general studies
University of Texas at Brownsville