Rachel Napoles

• Assisted in analyzing quality trends and provided details to Supervisors
• Training new hires in Financial Clearance role adhering to policy and procedure guidelines
• Providing coverage to ensure surgery cases are financially clear with onboarding of new surgery centers
• Providing teaching/training updates to fellow team members when needed
• Liaison between Ambulatory Surgery Centers leadership inquiries and team members when issues arise
• Participated in team meetings and training sessions to stay informed about updates and changes.

• Generate reports from Power BI, Unauthorized CPT and Unsecured Authorizations
• Verify authorization requirements for procedures that have been added or modified during surgical procedures
• Secure any unsecured authorizations from last 24-72hrs
• Track insurance trends such as insurance payers that will or will not allow us to initiate retro authorizations
• Work any same day add on’s received by center or leadership
• Assist with upcoming authorizations as needed
• Track insurance payer trends such as referral requirements and inform team of any updates and revisions
• Training new hires and team on new workflow job duties
• Creating training videos and verbiage for workflow processes
• Issuing refunds to patients via Elavon and Waystar payment applications, adding patients to refund request list for refunds owed in paper check form
• Documented all actions performed and interactions with customers.
• Assessed individual situations and developed effective and appropriate resolutions.
• Achieved performance goals on consistent basis.

• Confirm CPT codes via surgery orders are entered correctly
• Verify insurance payer and contract information
• Confirm benefit details and subscriber information and edit accurately
• Generate procedure estimate according to insurance benefit details
• Verify authorization requirements per CPT code/ICD10 code per insurance payer
• Securing authorizations if required
• Notifying ordering doctor’s and center of authorization issues immediately upon discovery
• Ensure all next day accounts are fully financially cleared
• Notifying ordering doctor’s and center of all insurance issues immediately upon discovery
• Ensure all next day accounts have insurance verified and estimates completed
• Complete ABNs as needed
• Complete Payer Code Add Request forms as needed and send to Managed Care
• Locate current online prior authorization tools or lists and upload into Compass and inform team of updates

• Greet patients, obtain, and verify demographic and insurance information for scheduled procedures
• Verify prior auth requirements
• Confirm and prepare schedules for dates of service
• Effectively communicate with nursing and medical staff regarding any issues or questions
• Completing appropriate documentation with patients for compliance
• Transferred to Insurance Verification Department
• Notified Various insurance payers of observation and In Patient admissions from the ER Department
• Notified various Insurance payers of New Born and Sick baby admissions from the OB Department
• Assisting in new born insurance applications in order to assist parents in adding to existing policy
• Quality oversight with documentation completed in ER and OB Departments and informing colleagues of an errors that needed attention
• Adhered to privacy and security compliance guidelines such as HIPPA
• Communicated with patients, ensuring that medical information was kept private.

Job duties same as noted below

• Verifies insurance eligibility and obtains benefits on all scheduled patient accounts by using electronic verification systems or by contacting payers directly to determine the level of insurance coverage
• Document insurance benefit information such as, deductibles, co-payments, coinsurance, and policy limitations
• Secures or verifies authorization and pre-certification
• Completes medical necessity check for outpatient services when Medicare is the payer using the diagnosis and procedure codes provided on the physicians’ order
• Completes the Advanced Beneficiary Notification (ABN) process if/when the code does not pass medical necessity
• Calculates patient’s financial responsibility
• Review assigned accounts to ensure accuracy and required documentation is obtained and complete
• Follows appropriate processes and procedures to ensure accurate billing and timely processes
• Collects and enters required data into the system with emphasis on accuracy of demographic and financial information in order to ensure appropriate reimbursement.

• Supported physicians Erik Dean, D.O., and Amit Sahasrabudhe, M.D
• Managing front office duties
• Implementing work flow changes to ensure efficiency
• Collected account balances and co-pays
• Updating records in EMR Practice Fusion
• Verifying account balance/credit amounts in Kareo
• Screened and transferred incoming calls, took down messages, and transmitted information and documents to internal personnel.
• Collect patient and client documents and information upon referral.
• Aided colleagues, managers, and customers through regular communication and assistance.
• Delivered top-notch administrative support to office staff, promoting excellence in office operations.

• Worked in support of the Office Manager and Director of surgery to ensure operational efficiency
• Started position though a staffing agency and then was hired on full time directly with USC
• Processed billing activities with GE Centricity Business
• Communicated with several departments for scheduling outpatient diagnostic exams
• Updated Financial postings and batching
• Provided Insurance verifications/authorizations
• Managed Co-pay /account balance collections
• Updated patient records
• Updated records in Keck Powerchart
• Worked with other departmental staff to answer questions and resolve mutual patuient problems.

• Performed data entry with adherence to polices for PHI (Athena)
• Greeted, registered and checked in patients.
• Provided forms to fill out or update and added latest information computer system.
• Ensured that patient needs are correctly prioritized and responded to in an appropriate manner
• Processed billing activities for specialty pharmacy medications
• Scheduled appointments, sent reminders and updated master calendar.
• Ran form copies, faxed information and made phone calls to patients, other providers and insurance companies.

• Scheduled appointments, sent reminders and updated master calendar.
• Greeted, registered and checked in patients.
• Determined amounts due and accepted payments.
• Ran form copies, faxed information and made phone calls to patients, other providers and insurance companies.
• Managed Co-pay /account balance collections
• Oversaw practice activities so that quality services are provided in a safe, efficient, effective, and timely manner meeting all applicable hospital and regulatory regulations as outlined in office protocols
• Trained new staff and updating office protocols as necessary

• Supported day to day operations
• Managed patient greeting and check in activities
• Coordinated correspondence to patients, insurance companies and referring physicians
• Assisted with insurance and optimizing patient experience
• Processed billing activities such as co-pay collections
• Screened and transferred incoming calls, took down messages, and transmitted information and documents to internal personnel.
• Collect patient and client documents and information upon referral.
• Aided colleagues, managers, and customers through regular communication and assistance.
• Monitored office supplies by checking inventory and placing orders.

• Scheduled and coordinated appointments, surgical procedures, pre-admission screening, and exams, for patients
• Reviewed all necessary referrals/pre-certifications
• Performed data entry for required updates to electronic health record
• Processed billing activities