Rebeca Rodriguez
Wesley Chapel,FL
Summary
Exceptional oral and written communication skills, active listening abilities, and analytical problem-solving capabilities. Enhances customer experiences through service-oriented behaviors, understanding customer desires, and providing customized solutions to build loyalty. Organized and dependable candidate with a proven track record of successfully managing multiple priorities with a positive attitude. Willing to take on additional responsibilities to meet team goals.
Overview
20
20
years of professional experience
Work History
Utilization Management Review
Elevance Health/Anthem
04.2022 - Current
- Responsible for coordinating cases for pre certification and prior authorization review
- Manage incoming calls and incoming post services claims work
- Authorize non clinical review authorization requests
- Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient pre certification, prior authorization and post service request
- Refer cases requiring clinical review to a Nurse Reviewer
- Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate
- Respond to telephone and written inquiries from clients, provider and in house departments
- Conduct clinical screening process
- Authorize initial set of sessions to provider
- Check and ensure customer requests and questions are handled appropriately and in a timely manner
- Route incoming faxes to multiple queues to be processed
- Knowledge of Medicare and Medicaid Line of Business
- Enhanced patient satisfaction by promptly addressing inquiries regarding coverage decisions and available resources.
- Ensured proper documentation and coding of medical treatments, enhancing billing accuracy and reimbursement rates.
- Increased overall efficiency by streamlining authorization processes for medical procedures.
- Served as a liaison between patients, healthcare providers, and insurance companies to facilitate timely approvals of necessary treatments.
Patient Surgical Coordinator/Front and Back Desk/Triage
Tampa Ear Nose and Throat /Florida Pediatric Associates
05.2012 - 04.2022
- Schedule patients pre operative and post operative appointments
- Obtain pre certification and authorization using Availaty, and various insurance provider portals
- Collect deductibles and coinsurance prior to scheduled procedures
- Educate patients about pre and post operative process
- Work directly with physician to ensure accurate interpretation for coding
- Obtain proper surgical clearance from multiple physicians for anesthesiologist to approve surgeries
- Facilitate communication between physician, hospitals, ambulatory surgery centers
- Triage phone calls and patient inquiries in a professional and efficient manner
- Scan and attach all documentation using EMR (electronic Medial Record) system
- Collect and process patient payments
- Register new and established patients
- Train all new employees
- Obtain reports from other hospital provider portals such as Tampa General Hospital, Baycare, Advent Health Florida Hospital, Labcorp, Tower Diagnostics etc
- Communicate using e-mail to resolve and handle daily work requirements
- Assist with covering front office responsibilities when short staffed
- Enhanced surgical team communication by maintaining accurate schedules and promptly addressing any changes or concerns.
- Maintained strict adherence to HIPAA regulations, protecting the privacy of patient information at all times.
Insurance Specialist/Interpreter/Financial Counselor
Shriners Hospital For Children
01.2005 - 12.2011
- Oversee and coordinate the scheduling of patients being sent off campus for outpatient MRI, CT Scans, Neurology Consults, Pulmonology, EMG/Nerve conducting Studies, Ultrasounds, Ophthalmology consults prescribed Physician Staff
- Call insurance companies to obtain medical eligibility and benefits information
- Obtain pre-certification and authorizations for scheduled visits
- Prepare appeal letters for medical denials
- Assist medical staff with translating to Spanish speaking patients
- Manage monthly, quarterly and yearly savings for outpatient department
- Liaison between care coordination, physicians, in-patient department, radiology department
- Assist in completing application for low income patient to obtain medical insurance
Education
High School Graduate - Medicare Education Certifications, Management Required Seminars, HIPPA Certification
Skills
- Microsoft Outlook
- CPT coding
- ICD-9/10 coding
- Microsoft Office Suite
- Availaty
- EMR
- Bilingual/Spanish
- Triage
- HIPAA Compliance Understanding
- Critical thinking abilities
- Professionalism and Ethics
- Documentation accuracy
- Healthcare regulations knowledge
- Insurance Verification
- Healthcare regulations
Timeline
Utilization Management Review
Elevance Health/Anthem
04.2022 - Current
Patient Surgical Coordinator/Front and Back Desk/Triage
Tampa Ear Nose and Throat /Florida Pediatric Associates
05.2012 - 04.2022
Insurance Specialist/Interpreter/Financial Counselor
Shriners Hospital For Children
01.2005 - 12.2011
High School Graduate - Medicare Education Certifications, Management Required Seminars, HIPPA Certification
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