Rolando Lugo
The Bronx,NY
Summary
With over 20+ years of Medical office experience I am a strong candidate for a company seeking a quality employee that can fit in quickly and make a positive impact.
Enthusiastic about helping patients get necessary medical support by obtaining authorizations, scheduling procedures and coordinating paperwork. Detail-oriented and proactive with good relationship-building skills, a hardworking nature and an adaptable approach. Proficient in scheduling applications such as Athena, Tidio, and Luma. With extensive knowledge of Microsoft products and applications.
Overview
16
16
years of professional experience
Work History
Patient Service Representative
Metro Vein Centers
49-10 Austell Place
07.2023 - Current
- Actively participated in team meetings focused on improving workflows and enhancing overall practice performance.
- Used Tidio, Luma and Athena systems along with excel driven customer request logs to schedule appointments for new and current patients for treatment.
- Built and maintained positive working relationships with patients and staff.
- Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
Provider Relations Rep
NBF
02.2015 - 09.2022
- Accurately process provider requests to update their status in the Funds' systems according to established workflows; identify failures in the workflow and propose solutions
- Respond to provider inquiries or requests via email, telephone and written correspondence
- Resolve complex provider claims and contracting issues; work with internal departments and management to resolve issues and recommend solutions
- Educate participating providers regarding policies and procedures; review existing policies to ensure maximum compliance, troubleshoot issues raised by providers, distribute any needed material, identify non-compliant providers, and providers with member complaints
- Coordinate provider recruitment activities through written correspondence and telephone calls; follow up on Letters of Intent, initiate out of network searches for highly specialized providers when needed
- Provide support to Account Representatives in managing account relationships; identify rates for services and codes not included in established fee schedules.
Patient Service Coordinator
Morris Heights Health Center
09.2012 - 04.2014
- Greeted and registered patients upon arrival to appointments while answering telephones and assisted with patient inquiries
- Verified insurances 1 day prior to patient appointments for over 8 providers within the Peds/OBGYN and Adult clinics
- Updated any new patient demographic when requested by providers/patients or appropriate staff members in order to insure that all patient contact information is up to date
- Obtained prior authorization for patients on upcoming procedures based on insurance coverage
- Created OBGYN tracking spread sheet to maintain updated records on patients with high risk pregnancy and scheduled follow up appointment for standard GYN services and COLPO procedures.
Service Care Manager
MJHS Hospice Care
10.2007 - 03.2011
- Managed 7 intake nurses in the field for admissions by coordinating travel routes to potential patients home, insure ring the delivery of durable medical equipment based on nurses assessment and developed daily procedures for the team
- Maintained constant conversations with providers, attending physicians, medical directors and effectively communicates any new policies or procedures to the clinical staff of over 9 nurses and 10 non medical staff members
- Assisted in resolving difficult and/or dynamic referral issues
- Worked closely with the 3 Chief Clinical Officers, 5 Team Managers from other boroughs, 12 hospice Rns and other support staff members to insure that services are delivered with high standards and in a timely manner
- Verified patients' benefits and eligibility, obtain authorization from private insurance companies, HMOs, and managed care organization
- Prepared end of day reports by compiling the daily results from 7 intake nurses that included admissions, open bed availability in several NYC hospitals (Roosevelt, Beth Israel, LICH) and updating daily stats of new referrals needing evaluation based on calls received in our call center.
Education
GED -
01.1997
Certified Word Processor - Word Processing
Skills
- Microsoft Excel
- Microsoft Word
- Customer service
- Microsoft Windows
- Medical Office Experience
- Bilingual
- Spanish
- Communication skills
- Data entry
- Phone etiquette
Proficient In Applications
- Windows 11
- Vista
- All Microsoft office 2021 applications
Knowledge Of Medical Programs
- Athena
- Luma
- Tidio
- Eagle
- Pinnacle
- Argi
- Lotus
- Suncoast All-Scrpits
- PERC
- FileMaker softwar
- SuperScreen
- V3
- QNXT systems
Typing Skills
60wpm with limited errors
Timeline
Patient Service Representative - Metro Vein Centers
07.2023 - Current
Provider Relations Rep - NBF
02.2015 - 09.2022
Patient Service Coordinator - Morris Heights Health Center
09.2012 - 04.2014
Service Care Manager - MJHS Hospice Care
10.2007 - 03.2011
Dewitt Clinton High School - GED,
Educational Opportunity And Career Center (E.O.C) - Certified Word Processor, Word Processing