Priscila Munoz
San Bernardino,CA
Summary
Dedicated Enroll/Eligibility Representative with proven expertise in client relationship building and policy interpretation. Adept at enhancing customer service and streamlining eligibility processes.
Overview
13
13
years of professional experience
Work History
Enroll/Eligibility Representative
Optum
Redlands, CA
06.2019 - Current
- Assessed eligibility requirements for diverse healthcare programs, ensuring compliance with regulatory standards.
- Processed complex applications efficiently, enhancing workflow and reducing processing times.
- Provided exceptional customer service by resolving inquiries regarding coverage and benefits effectively.
- Collaborated with cross-functional teams to improve eligibility determination processes and enhance accuracy.
- Collaborated with team members to maintain accurate records and provide seamless service for applicants.
- Ensured timely resolution of discrepancies by conducting thorough research and documentation.
- Reduced errors in eligibility determinations through meticulous attention to detail and rigorous quality control measures.
Financial Services Representative
Loma Linda Shared Services
Loma Linda, CA
10.2012 - 06.2019
- Managed insurance authorization processes to ensure timely approvals and compliance with industry regulations.
- Collaborated with healthcare providers to gather necessary documentation for authorization requests.
- Trained and mentored junior staff on best practices for processing authorizations efficiently.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Verified eligibility and compliance with authorization requirements for service providers.
- Verified patient insurance information for accuracy, ensuring compliance with healthcare regulations.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Education
Business Administration
San Bernardino Valley College
San Bernardino, CANo Degree - Language Interpretation And Translation
Southern California School of Interpretation
El Segundo05-2027
Skills
- Client relationship building
- Healthcare industry
- Policy interpretation
- Microsoft office, Excel, Outlook
- Customer service
- Eligibility determination
- Referral coordination
- Assistance authorization
- EZCAP knowledge
- Insurance knowledge
- Medicare and Medical Knowledge
- Epic Knowledge
- Authorization procurement
- CPT codes knowledge
Languages
Spanish
Timeline
Enroll/Eligibility Representative
Optum
06.2019 - Current
Financial Services Representative
Loma Linda Shared Services
10.2012 - 06.2019
Business Administration
San Bernardino Valley College
No Degree - Language Interpretation And Translation
Southern California School of Interpretation