Sonya Morales
San Antonio,TX
Summary
To obtain a position that will enable me to use my strong bilingual, organization skills, education background, leadership skills, and hardworking attitude to thrive as a business professional. Driven Pharmacy Technician with 15 years of experience and success in working within fast-pace call center medical settings. Excited to bring talent and record of excellence in customer service to growing corporation . Capable pharmacy team member proficient in assisting Agents with defusing escalated call and meeting customer needs. Safety-oriented and well-organized with solid experience coordinating with insurance providers, prescribers and individuals to address issues. Good relationship-building and multitasking skills. Capable pharmacy team member proficient in assisting pharmacists with preparing prescriptions and meeting customer needs. Safety-oriented and well-organized with solid experience coordinating with insurance providers, prescribers and individuals to address issues. Good relationship-building and multitasking skills.
Overview
15
15
years of professional experience
Work History
Quality clinical admit
United health care
10.2022 - Current
- Provider /Pharmacy to minimize time between medication needs are met, Monitor all Incoming high volume calls for request on prescription renewals, Identified Request that fall outside Prescription Renewals, Monitor for and respond to in coming request for prior Authorization Utilizing different platforms, Document Prior Authorization process per procedure and update status as appropriate, Document Medication Non-Adherence in the various EMR VIA phone notes for patients who have frequent incidences of RTS for chronic medications, RXClaims, Trucare , ScoreCard, IKA , ECW , EPG and various other platforms and EMR’s
Clinical Coder
WELLMED MEDICAL MANAGEMENT
10.2019 - 10.2022
- Proficient with HCCs and (ICD-10-CM) codes, Assist in training / taking leadership roles to adhere specific Coding requirements, Adhere to different campaigns/projects according to business need, Calling Patients to address open HEDIS gaps in health care, Calling member to scheduled appointment with PCP, Collect appropriate data with HEDIS to submit via ESDS, High volume Call center incoming and outgoing calls, Meet daily coding production of 50-60 charts/day, Managing referrals, UAT testing User acceptance testing \ thru zepher project, Working with hospitals, clinics, for discharge paper work, Able to make and received calls using Dialer and VCC system, Enters detailed information into a tracking system, Abide by AHIMA and/or AAPC coding Code of Ethics, Trucare-EPRG-IKA-Data RAPS- Zephyr | OZ and UPGRADE COSMOS, MAESTRO, Pulse applications, Access to up to 15 hospital not only in San Antonio but Florida market to obtain medical records, Caller concerns – ability to defuse complex calls, Verifying and coding of the diagnosis, evaluation and management, procedures or other codes required for the completeness and accuracy of the record, Ensure that all codes are current and active
Lead Medical Assistant –Billing Coordinator
WELLMED MEDICAL MANAGEMENT
01.2015 - 10.2019
- Handled patient scheduling (checking in/out patients) intake processing, and payments- ICD9-CPT CODES, Processing Accounts Receivable/Billing/Insurance, verified medical coding and insurance, Triage/discharged patients, Process e-scripts, Verify primary/secondary payer protocol and seek pre-authorizations, Aggressive follow up in collecting information/data from insurance companies, Confirm VA benefits- confirm VA payments, Insurance Verification, Medical Records – processing subpoenas and affidavits, administering injection, medications, phlebotomy, Ear lavage, EKG, DPN, Flocheck, Spirometer, Referrals, prior authorizations, Telephone encounters and customer service, Assist with minor surgery -Suture/Staple removal, cast removal Drug testing, hearing screenings, Ear lavage IV set up and administration Electronic Health Record, train all new employees who enter the office
Facility Lead Coder
Methodist hospital
01.2014 - 01.2015
- Receives and reviews charge documents from the clinic and/or hospital, Multiple specialist including ER , Pediatrics , Orthopedic, Rheumatology , Inpatient , Family Practice, Geriatrics, Ensures charge information provided is correct and accurate, Abstracts CPT-4, HCPCS II and ICD-9-CM from medical records, Charge entry into billing system, Works in conjunction with A/R team on follow up and resolution of coding related denials and rejections, Tracks denial patterns to address systemic issues, Available to assist and direct the practice or other appropriate staff regarding documentation, billing, coding, and reimbursement issues, Performs related work and projects as required, Meets designated productivity and accuracy rate of 95%, Knowledge of eCW billing system and/or other related billing system, Trucare-EPRG-IKA-Data RAPS- Zephyr OZ and UPGRADE COSMOS, Pulse applications, Knowledge of medical terminology, Knowledge of medical coding including CPT-4, HCPCS II and ICD-10-CM, Certified Professional Coder CPC
Lead Mobile Phlebotomist
Texas blood and tissues center
01.2009 - 12.2013
- Greet donors, Assist in the unloading, setting up, taking down and reloading of mobile equipment, Perform quality control function, Determine donor eligibility through comprehensive medical history interview, medical screening procedures (blood pressure, pulse, temperature, Hgb/Hct via finger stick), Ensure all necessary records are legible, accurate and complete, Perform phlebotomy procedures of over 50 donors a day, Assess and treat adverse donor reactions, Perform record review and data entry, Performs specimen receipt and distribution of laboratory specimens
Education
Diploma -
Memorial High School
Dasics -
San Antonio College
Business Management -
Carrer Point College
Skills
- Assist in training all new employees
- NICE
- Supervising Call center
- Billing and Coding
- Dialer / VCC knowledge
- System Analyst
- Proficiency in using EPRG – ECW – Athena electric medical records
- Submitting referral to specialist
- Proficient using Ika –Data RAPS – Trucare
- Proficient with HEDIS measure
- Knowledge of CAPS and HOS
- Logistic Analyst
- Medical records – review process subpoenas affidavits accordingly –
- Data entry
- Appeals
- OZ and Upgrade
- Claims
- UHC West – insurance verification for PPO insurances – Prior Authorizations –insurance claims
- Proficient with Evicore – MRI submission
- Availity –Emdeon –HMO insurance verification submissions and prior authorizations
- RX-claims
- NICE application
- Maestro application
- Data Entry
- Certified Professional Coder CPC
- COSMOS
Languages
Spanish
Native or Bilingual
Timeline
Quality clinical admit
United health care
10.2022 - Current
Clinical Coder
WELLMED MEDICAL MANAGEMENT
10.2019 - 10.2022
Lead Medical Assistant –Billing Coordinator
WELLMED MEDICAL MANAGEMENT
01.2015 - 10.2019
Facility Lead Coder
Methodist hospital
01.2014 - 01.2015
Lead Mobile Phlebotomist
Texas blood and tissues center
01.2009 - 12.2013
Diploma -
Memorial High School
Dasics -
San Antonio College
Business Management -
Carrer Point College
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