Rodika Alveranga
Winder,GA
Summary
Compassionate Patient Access Representative well-versed in performing diverse administrative functions for patient care with a high degree of diplomacy and problem-solving acumen. Positive and upbeat team player with good communication and time management abilities. Demonstrated extreme attention to detail with accuracy of medical records.
Overview
12
12
years of professional experience
Work History
Patient Access Representative
Northside Hospital
Alpharetta, Georgia
03.2021 - 03.2023
- Interviews and performs data entry on patient information necessary for admission, billing and collection including patient’s demographics, insurance coverage and medical reason for admission
- Prepares patients’ account folders for each admission, ensuring that each folder contains copies of insurance cards and admission paperwork
- Assigns appropriate medical record number and patients’ account number
- Verifies that the information collected is accurate and complete
- Calculating patients’ payment information and accepting funds
- Prioritizing order of admission for patients
- Identifies patients with inadequate insurance coverage and refers them to Financial Counselor
- Obtains information and signatures necessary for the consent for treatment, insurance forms Medicare, and other forms as appropriate
- Prepare patients' identification information (which may include the patient’s identification band), arranges for escort of patient to their room or directs patients to appropriate area
- Familiar with Rev Runner Change Healthcare systems
- Experience for Surgery, Radiology, Oncology, Breast care, Women’s care, Lab work, Genetic and blood infusion Patient registrations.
Claims Processing Specialist
Healthcare
Atlanta, Georgia
10.2017 - 03.2021
- Input all referrals and log sheets that are received in office the same business day to validate inventory reports
- Process and input all state and Federal applications into the Citrix (Pace) database within 24 hours of arrival in office
- Contact Health Care Representatives regarding incomplete claims or claims that have not been received in office within the allotted timeframe
- Accurately sort and prepare documents for data imaging and indexing
- Prepare and send out mail daily to the appropriate Government agencies.
Social Security Disability Income Advocate
Change Healthcare
Atlanta, Georgia
08.2014 - 10.2017
- Interview clients from different health plans to assist the clients in obtaining maximum benefit coverage
- Completion of applications for state and federal programs (including Health Exchange/ Marketplace programs), reviewing medical records and taking all necessary action to expedite benefit approval
- Adherence to company and legal standards regarding Protected Health Information (PHI), Personal Identifiable Information (PII) and Personnel Transaction Identifier (PTI)
- Maintain ongoing communication with government agencies regarding the status of claims
- Maintain documentation of status of claims and client contract on Change Healthcare computer systems
- Making a determination to take a Federal, State or Local program application based upon medical definition of disability as it relates to body systems and to functions of daily living, and information contained in medical records.
Referral Specialist
Elevance Health
Atlanta, Georgia
04.2023 - Current
- Initiates and manages clinical referrals for pre-authorization.
- Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
- Reviews referrals for completeness and follows up for additional information if necessary.
- Assigns escalated referrals to staff as appropriate.
- Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, etc.) following established process and procedures.
- Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.
- Contacts physician offices as needed to obtain demographic information or related data.
- Enters referrals, documents communications and actions in the system.
Education
Associate in Business Administration - Business Administration And Management
University of Technology Kingston, St Hugh’s High School
01.2011
High School Diploma -
St. Hugh’s High School
Kingston, JA07.2007
Skills
- Excellent written/verbal communication skills
- Excellent customer service skills
- Ability to prioritize and time management skills
- Excellent listening skills
- Computer skills:
- Windows and MS office, Word, Excel, Power Point, Outlook and Publisher
- Regulatory compliance
- Insurance company knowledgeable
- Payment processing
- Appointment scheduling
- Team management
Timeline
Referral Specialist
Elevance Health
04.2023 - Current
Patient Access Representative
Northside Hospital
03.2021 - 03.2023
Claims Processing Specialist
Healthcare
10.2017 - 03.2021
Social Security Disability Income Advocate
Change Healthcare
08.2014 - 10.2017
High School Diploma -
St. Hugh’s High School
Associate in Business Administration - Business Administration And Management
University of Technology Kingston, St Hugh’s High School