Selena Garcia
Cicero,IL
Summary
Proficient with Microsoft Word, Excel, Power Point and the Internet
Experienced with coordinating complex prior authorization processes. Utilizes excellent organizational skills to maintain accurate records and ensure timely approvals. Knowledge of healthcare regulations and payer requirements, leading to efficient and compliant authorization management.
Overview
12
12
years of professional experience
Work History
Prior Authorization Coordinator
Kindbody
Chicago, IL
07.2025 - 03.2026
- Managed prior authorization processes to ensure timely patient access to services.
- Collaborated with clinical staff to gather necessary documentation for approval requests.
- Trained new team members on workflow procedures and compliance standards.
- Analyzed authorization trends to identify areas for process improvement and efficiency gains.
- Developed and maintained relationships with insurance providers to facilitate seamless communication.
- Implemented tracking systems to enhance accuracy in authorization status updates.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Monitored regulatory changes impacting prior authorization practices, ensuring adherence across operations.
Verification of Benefits Specialist
Kindbody
Chicago, IL
03.2023 - 07.2025
- Verify patient insurance benefits
- Explain insurance coverage and treatment costs and identify the need for any pre-authorizations
- Advise patients of coverage, limitations and exclusions, co-insurance, deductible, special
- Communicate coverage, via electronic, phone, and in person communications
- Determine patient responsibility amounts in advance of the related procedures
- Serve as a Patient Advocate for patients when patients have difficulty navigating with their insurance company
- Respond to patient calls/correspondence regarding billing questions, financial policies, claims submission
- Review of medical records for required information related to authorization requirements
- Communicate to clinic about pre authorization requirements and any update any changes
- Update patient accounts, including verification of insurance coverage and changes in patient information, with appropriate documentation.
- Meet positional metrics and benchmarks.
- Follow all department standard operating procedures carefully and accurately
- Other duties as assigned by the Director.
Referral Specialist/ Call Center Representative
John H. Stroger Jr. Hospital of Cook County
Chicago, IL
01.2021 - 03.2023
- 4-HELP Call Center Representative responsibilities:
- Answer incoming calls and respond to staff's emails.
- Management and resolve staff complaints.
- Place staff work orders in the computer system.
- Identify and escalate issues to supervisors.
- Provide service information to staff member.
- Speak to tradesman on any concerns about work orders.
- Hospital rounds to make sure building is up to date.
- Covid-19 Vaccine Call Center Representative responsibilities:
- Respond to patients via telephone by assessing needs and answer general questions regarding treatment options.
- Register and schedule new patients. Send appropriate patient materials prior to initial appointment.
- Schedule all patient appointments. Make appropriate scheduling changes, canceling, rescheduling and confirming appointments.
- Provide excellent customer service by anticipating patient needs.
- Maintain operations by following policies and procedures. Report changes as needed.
Insurance Verifier
FERTILITY CENTERS OF ILLINOIS
12.2015 - 08.2020
- Enter authorization or precertification information into NextGen, Felix and Art Works in appropriate location.
- Extend expired authorizations when treatment has been delayed.
- Identify any need for peer-to-peer, letter of medical necessity or other documentation to obtain treatment precertification and notify provider immediately.
- Uses the insurance verification systems to contact the patient and their partner’s insurance to verify benefits, identify benefit maximums, and coordination of benefits.
- Enters information obtained through such contact into the patient and their partner’s Insurance Verification Form (IBV) Form in Felix prior to the patient’s first appointment.
- Advises FCI if it is determined that a patient’s benefits do not cover infertility treatment and that they will be in a Self-Pay status, if they wish to receive treatment. Also, inactivates the patient and their partner’s insurance in the billing system, if it is determined that they have no insurance benefits.
- Assists in the maintenance of the patient and their partner’s account by obtaining, accurately recording, and updating personal and financial information as required. When needed, coordinates the completion of a new FCI IBV Form for both the patient and their partner.
- Ensures all insurance requirements are met, secures payer authorizations with insurance for required services in an expeditious manner, and ensures that all documentation is entered according to division workflow to facilitate information sharing with all staff.
- Documents progress of requests and follow up in information systems until requirement is satisfied and treatment can be approved.
- Green light approved treatment cycles in a timely manner.
Film Crew Member
AMC Yorktown
Lombard, IL
05.2015 - 11.2015
- Performed cashier duties
- Usher theaters
- Service patrons with their food orders
- Lobby Porter
- Provided assistance where needed
Snack Bar Attendant
Brunswick Zone
River Grove, IL
12.2013 - 02.2015
- Handled money and performed cashier duties
- Prepared and portioned meals
- Serviced patrons with their food orders and various needs
- Provided table set-up and removal
- Provided minor kitchen maintenance
- Obtained verbal customer service survey information from patrons
Education
Diploma -
Morton High School
Cicero, IL01-2012
Skills
- Authorizations
- Benefit coverage
- HIPAA compliance
- Retro-authorizations
- ICD-10 coding
- Data entry
- CPT coding
- Precertification requirements
- Teamwork
- Customer service
Languages
English
Full Professional
Spanish
Limited Working
Timeline
Prior Authorization Coordinator
Kindbody
07.2025 - 03.2026
Verification of Benefits Specialist
Kindbody
03.2023 - 07.2025
Referral Specialist/ Call Center Representative
John H. Stroger Jr. Hospital of Cook County
01.2021 - 03.2023
Insurance Verifier
FERTILITY CENTERS OF ILLINOIS
12.2015 - 08.2020
Film Crew Member
AMC Yorktown
05.2015 - 11.2015
Snack Bar Attendant
Brunswick Zone
12.2013 - 02.2015
Diploma -
Morton High School