Saile Vallejo
Weslaco,TX
Summary
Professional with extensive experience in referral processing and insurance verification within healthcare settings. Demonstrated ability to interpret complex benefit plans and ensure compliance with regulatory standards while managing patient inquiries effectively. Developed strategies to enhance departmental efficiency, resulting in improved service delivery and resolution of escalated patient complaints. Proven track record of facilitating communication among healthcare professionals to streamline referral processes and improve patient outcomes.
Overview
8
8
years of professional experience
Work History
Referral Specialist
Kaizen Clinical Partners
Weslaco, TX
12.2022 - Current
- Processed incoming referral requests for medical services and submitted them to the appropriate insurance companies for authorization.
- Interpreted complex benefit plans accurately when determining whether requested services are covered under an individual's policy.
- Verified insurance eligibility for referred services using online databases and contacted insurers directly when needed.
- Resolved escalated patient complaints relating to denied or delayed referrals promptly.
- Tracked progress of each referral throughout its lifecycle from submission through authorization or denial notification.
- Reviewed all documentation associated with each referral request to ensure compliance with relevant regulations.
- Assisted patients in understanding their insurance coverage and answered questions about referrals, authorizations, and other related issues.
- Communicated regularly with referring physicians, nurses, case managers, social workers, and other healthcare professionals regarding referral processes and requirements.
- Developed strategies for improving efficiency within the department while maintaining high standards of customer service.
- Identified potential problems with referrals before submitting them to insurers and worked with providers to resolve those issues quickly.
- Participated in staff meetings and provided feedback on ways to improve procedures related to referral processing.
- Provided support to referring physicians in obtaining pre-authorization for services as necessary.
- Educated patients on how their health plan works so they can make informed decisions about their care options.
- Researched and responded to inquiries from providers regarding pending or denied referrals in a timely manner.
- Answered questions and resolved concerns raised by both patients and specialists.
- Collected and analyzed referral data and tallied number of referrals.
- Facilitated communication between primary care physicians, specialists, and patients to ensure a smooth referral process.
- Monitored referral outcomes, reporting on trends and areas for improvement to healthcare management teams.
Receptionist
Kaizen Clinical Partners
Weslaco, Texas
05.2022 - Current
- Prepared welcome packages for new hires.
- Provided administrative support to staff members including typing letters, filing documents, and scanning and copying documents when necessary.
- Verified visitors' identification cards before allowing access to the building.
- Answered incoming calls, took messages, and transferred calls to appropriate departments or personnel.
- Greeted visitors and provided them with assistance.
- Provided excellent customer service at all times while interacting with both internal and external customers.
- Scheduled appointments for clients, customers, and other visitors.
- Maintained an organized filing system of confidential client information in accordance with company policy.
Medical Assistant
Dr. Gregoris Nuñez
Weslaco, TX
04.2017 - 12.2017
- Provided assistance to medical staff in performing minor surgical procedures.
- Educated patients on healthcare topics such as nutrition and disease prevention methods.
- Administered injections, medications and treatments as directed by the physician.
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Inspected equipment to ensure proper working order prior to use on patients.
- Collected samples from patients for laboratory testing purposes.
- Prepared laboratory specimens for analysis and organized lab results for review by the physician.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Maintained accurate medical records through filing, charting, transcription and data entry into electronic health record system.
- Performed basic laboratory tests such as urinalysis and blood glucose levels under direct supervision of a physician or registered nurse.
- Answered phones, scheduled appointments and managed patient flow while greeting visitors in a professional manner.
- Ensured that all instruments used during exams were cleaned properly after each use according to established protocols.
- Documented notes during patient visits.
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
Education
Medical Assistant
South Texas Vo-Tech
Weslaco, TX06-2017
High School Diploma -
Weslaco East High School
Weslaco, TX05-2016
Skills
- Referral processing
- Insurance verification
- Benefit interpretation
- Regulatory compliance
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Referral Specialist
Kaizen Clinical Partners
12.2022 - Current
Receptionist
Kaizen Clinical Partners
05.2022 - Current
Medical Assistant
Dr. Gregoris Nuñez
04.2017 - 12.2017
Medical Assistant
South Texas Vo-Tech
High School Diploma -
Weslaco East High School