Rachelle Hernandez
SAN ANTONIO
Summary
Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows.
Overview
6
6
years of professional experience
Work History
Prior Authorization Specialist
CVS Caremark
06.2021 - 03.2025
- Reviewed and processed prior authorization requests for accuracy and compliance with guidelines.
- Collaborated with healthcare providers to gather necessary documentation for patient medication approvals.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Assisted in training new staff on prior authorization protocols and system navigation.
- Collaborated with physicians and their staff to obtain necessary clinical information for prior authorization submissions.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
Medical Assistant
Diabetes and Glandular Disease Clinic
08.2020 - 06.2021
- Assisted in patient intake, gathering medical history and vital signs for effective treatment planning.
- Coordinated appointment scheduling to optimize clinic workflow and enhance patient experience.
- Maintained accurate electronic health records, improving data retrieval and patient tracking efficiency.
- Educated patients on diabetes management strategies, enhancing their understanding and self-care capabilities.
- Conducted routine laboratory tests, ensuring timely reporting of results for informed clinical decisions.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Built strong relationships with patients through effective communication skills that foster trust in the clinic''s commitment to quality care.
Medical Assistant
Alamo Orthopedics
08.2019 - 08.2020
- Collaborated with healthcare team members to develop personalized care plans tailored to individual patient needs.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Assisted in scheduling surgical procedures with hospitals.
- Helped improve patient outcomes by educating and advising on relevant treatments and care.
- Assisted with wound care, cast placement and removal, suture removal, and sterilization.
Education
Bachelor of Science - Cyber Security
Purdue University Global
Indianapolis, IN08-2024
No Degree - Medical Assistant
Everest College
Colorado Springs, CO08-2012
Skills
- Prior authorization process
- Quality assurance practices
- HIPAA compliance
- Authorizations
- Effective communication skills
- Data entry
- Medical terminology knowledge
- Process improvement strategies
- Workflow management
- Patient confidentiality compliance
Timeline
Prior Authorization Specialist
CVS Caremark
06.2021 - 03.2025
Medical Assistant
Diabetes and Glandular Disease Clinic
08.2020 - 06.2021
Medical Assistant
Alamo Orthopedics
08.2019 - 08.2020
Bachelor of Science - Cyber Security
Purdue University Global
No Degree - Medical Assistant
Everest College