Summary
Overview
Work History
Education
Skills
References
Personal Qualifications
Timeline
Generic

Sophia Delgadillo

Paramount,CA

Summary

Healthcare Coordination Specialist with a proven track record in optimizing referral processes at UCLA Health. Enhanced patient care through meticulous insurance verification and efficient scheduling, resulting in significantly improved referral response times. Strong customer service skills and expertise in medical terminology underpin a commitment to managing critical healthcare operations effectively.

Overview

11
11
years of professional experience

Work History

INSURANCE REFERRAL COORDINATOR

UCLA Health
LOS ANGELES, CA
07.2022 - Current
  • Maintained awareness of government regulations, health insurance changes and financing options.
  • Verified documents and associated records to catch and resolve discrepancies.
  • Collaborated with multi-disciplinary staff to improve overall patient care and response times.
  • Communicated regularly with patients regarding their care plans following a referral.
  • Conducted outreach to community providers for referrals and resources.
  • Utilized various healthcare IT systems to schedule appointments and communicate with medical professionals and patients.
  • Prioritized referrals according to urgency and adhered to appropriate referral deadlines.
  • Maintained communication and transparency with governing boards, department heads and medical staff.
  • Scheduled patients according to availability, urgency and insurance authorization guidelines.
  • Coordinated with external agencies to ensure timely processing of referrals.
  • Facilitated communication between primary care physicians, specialists, and patients to ensure a smooth referral process.
  • Monitored patient progress throughout the referral process.
  • Reviewed medical records to determine if additional services are needed prior to making a referral.
  • Conducted follow-up with patients and healthcare providers to ensure satisfaction and address any concerns post-referral.
  • Examined claims, records and procedures to grant approval of coverage.
  • Adhered to HIPAA requirements to safeguard patient confidentiality.
  • Monitored and tracked the status of pending insurance verifications and authorizations.
  • Educated patients on their insurance benefits and coverage limitations.
  • Conducted follow-ups with insurance companies to expedite verification processes.
  • Updated patient and insurance data and input changes into company computer system.

Administrative Assistant III

UCLA Health
11.2018 - 07.2022
  • Coordinated timing of surgical procedures including colonoscopy, endoscopy, and sigmoidoscopy.
  • Performed insurance authorization and verification for major medical plans.
  • Exhibited proficiency in typing by delivering accurate forms and communication promptly.
  • Delivered exceptional service to ensure seamless communication between healthcare teams and clientele.
  • Skilled at managing diagnostic and billing frameworks.
  • Managed task prioritization and met deadlines with minimal oversight.
  • Demonstrated proficiency in medical terminology.
  • Optimized workspace through advanced organizational skills.
  • Adapted to evolving procedures with consistent efficiency.
  • Ensured accurate reimbursement by applying knowledge of State and Federal programs involving Medicare, Medi-Cal, as well as other sponsoring entities.
  • Analyzed data and practices to identify options.
  • Collaborated effectively with clinic team to troubleshoot and resolve challenges.
  • Skill in recognizing an emergency or high-priority situation and taking appropriate and immediate action.
  • Responded professionally to confrontations.
  • Demonstrated proficiency in clear communication.
  • Demonstrated initiative by addressing problems promptly and working cohesively with team to maintain confidentiality.

Medical Receptionist

West Coast Urology
06.2015 - 11.2018
  • Responsible for registering patients, compiling complete and accurate information for patient records and timely reimbursement
  • Maintains effective patient flow and completes the admitting process in a timely manner to assist in prompt treatment of the patient
  • Maintains effective working relations with coworkers, nurses, physicians and other hospital staff members in order to insure workflow effectiveness
  • Greets and assists all customers and visitors, whether in person or by telephone, using guest relation techniques while professionally

Medical Receptionist

Arthur J. Edelstein MD.
03.2014 - 06.2015
  • Company Overview: (Ophthalmology)
  • Validated accuracy of medical and ocular records before entering them into the system.
  • Responsibilities include obtaining accurate patient records (medical history/patient intake), quoting fees, insurance verification, explaining insurance benefits to patients, Scheduling Appointments and Surgeries, Answering heavy volume of calls
  • In taking Emergency Consults, Collecting Co-payments, Posting Payments, In-putting authorizations, calling and confirming appointments
  • (Ophthalmology)

Education

Diploma - General Education

South East High School
South Gate, Ca
06.2007

Skills

  • Covid-19 Patient Screener
  • Supervisor Skills
  • Customer Service
  • Credit Accounts
  • Taking Payments
  • Cashier duties
  • Store Profits
  • Telemarketing
  • Insurance verification
  • Data Entry
  • Knowledge of EMR
  • Able to handle heavy incoming calls
  • Filing
  • Medical records
  • Chart Preparations
  • Appointment Scheduling
  • Submit Insurance Referrals and Authorizations
  • Inventory
  • Typing (60 wpm)
  • Retail Sales
  • Store Deposits
  • Patient records oversight
  • Notetaking and documentation
  • Insurance precertification processes
  • Outbound calls
  • Diagnostic appointments
  • Referral tracking
  • Follow-up coordination
  • Referring physician communication
  • HIPAA regulations
  • Healthcare systems
  • Electronic patient charts
  • Medical terminology
  • Medical terminology knowledge
  • Pre-authorizations
  • Physician authorizations
  • Referrals processing
  • Patient referrals expert
  • Health service referrals
  • Specialist referrals
  • Customer service
  • Account maintenance
  • Medicaid
  • Insurance billing
  • Data verification
  • Eligibility determination
  • Prior authorization processing

References

Available Upon Request

Personal Qualifications

  • Bilingual English/Spanish
  • EMR: EPIC, Care Connect and NextGen
  • Knowledge of MS Word, Excel, and Power Point

Timeline

INSURANCE REFERRAL COORDINATOR

UCLA Health
07.2022 - Current

Administrative Assistant III

UCLA Health
11.2018 - 07.2022

Medical Receptionist

West Coast Urology
06.2015 - 11.2018

Medical Receptionist

Arthur J. Edelstein MD.
03.2014 - 06.2015

Diploma - General Education

South East High School

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Sophia Delgadillo