Sophia Garcia
Katy,TX
Summary
Patient and Customer focused Administrative Professional with over 10 years' experience. Expert in all elements of patient care and successful in working as part of a team to treat a wide range of medical conditions. Skilled in prioritizing patients' needs within high-stress environments.
Overview
16
16
years of professional experience
Work History
Insurance Verification Specialist
TEXAS DERMATOLOGY SPECIALISTS
2023.07 - Current
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Updated patient records with accurate, current insurance policy information.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Prepared and processed patient referrals and transfer requests.
Leasing Specialist
PICERNE REAL ESTATE GROUP
2022.05 - 2023.02
- Answered phone calls and emails and responded to questions from prospects quickly and effectively.
- Set appointment times for individuals to tour facilities and see available units.
- Showed apartments to potential tenants and answered questions regarding community.
- Regularly inspected curb appeal of facilities to keep property great shape.
- Distributed and followed up on tenant renewal notices.
- Collected, completed and processed lease applications.
- Kept accurate records of all resident and tenant correspondence.
- Reviewed aged vacancies, market-ready apartments, and models and completed and updated market surveys.
- Trained leasing professionals on regulatory requirements, company policies and office procedures.
- Followed-up with potential accounts and managed daily and weekly marketing and leasing reports.
- Kept meticulous records of correspondence between management and tenants.
- Conducted property tours with potential rental clients and answered all questions truthfully regarding facility.
- Performed background checks on apartment applicants.
Patient Access & Referral Specialist-Contractor
SUTTER HEALTH VALLEY HOSPITALS
2019.10 - 2022.01
- Verified insurance benefits and eligibility for services and procedures before referring clients.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Entered correspondence using EPIC to document referrals and results.
- Received, recorded and addressed incoming and outgoing communication via telephone and email.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
Communications Operator
KAISER PERMANENTE
2018.05 - 2019.01
- Relayed latest information to first responders via electronic means, telephone calls, and radio responses.
- Answered calls from automatic routing system and took basic information from callers.
- Investigated and resolved customer inquiries/complaints in timely and empathetic manner.
- Directed calls to appropriate individuals and departments.
- Communicated directly with doctors' offices via telephone, fax, and email.
- Cultivated client rapport by interfacing with callers to aid with medical emergencies.
- Automated document flow by ensuring logbooks and fire, accident, and emergency reports were maintained with 100% accuracy.
- Eliminated risks and emergency response delays by efficiently monitoring public safety field units.
- Optimized productivity to ensure on-time emergency response and life support.
- Increased timely treatment protocols by leveraging current response and quality assurance requirements.
- Enhanced productivity by guaranteeing timely emergency response with no service delivery issues.
Patient Care Coordinator
TMS HEALTH SOLUTIONS
2017.03 - 2018.05
- Checking in and out patients, answer telephones, and send clinical notes to providers regarding any patients' needs.
- Communicate and assist Providers on any given task.
- Contact various insurance agencies and complete benefits investigation for each patient for every visit.
- Send completed Prior Authorization forms to insurance companies to try and obtain authorization for specific medical procedures and medication approvals.
- Collect co-pays and any outstanding balances
- Batch out daily collections at end of day.
- Evaluate and modify effectiveness of SOP's when necessary.
- Communicate and cordially work with other staff to ensure efforts are coordinated and high quality of service is provided.
- Maintained confidentiality and compliance standards at all times.
- Reviewed each step of patient care and made proactive adjustments to avert issues.
- Resolved issues such as billing or communication problems that could affect care.
- Coordinated charitable, government, and community resources for patients.
- Worked closely with patients to ensure excellent and individualized patient care.
- Weighed patient need, provider availability, and insurance coverage to determine optimal scheduling.
- Acted as main point of contact for patients, doctors and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
Specialty-Referral Coordinator
U.S. HEALTHWORKS MEDICAL GROUP
2015.08 - 2017.01
- Ran and maintained Specialty department while assisting clinic's Medical Director and various Specialists.
- Prepared medical charts and records for specialty patient visits.
- Tracked and filed test results, films, and/or reports prior to appointments.
- Reviewed second level text for specific protocols requested by client and advise specialty physician accordingly.
- Obtained authorizations from clients and insurance carriers for treatments as prescribed by physicians.
- Obtained authorizations for patient referrals to specialists, diagnostic testing, and surgeries.
- Updated and advised physician on referral status of treatments requested.
- Maintained records of all referrals and completed monthly reports.
- Created daily and monthly billing and scan utilization reports.
- Assisted Front Office personnel by answering telephones, registering and discharging patients.
- Called insurance companies to get pre-certification and other benefits information on behalf of patients.
- Trained 10+ staff on referral and intake process
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Scheduled appointments with specialists on behalf of clients.
Assistant Provider Network Specialist
VSP GLOBAL
2014.11 - 2015.08
- Provided exceptional support to field staff in Provider Relations and directly with VSP Providers.
- Performed analysis of given data and draw accurate inferences in accord with objectives of analysis.
- Gathered data required to conduct analysis from several sources, compile together in prescribed format, and enter data in several data analysis software.
- Evaluated given problem, situation, and crisis; investigate for solutions using data analysis practices and prepare reports.
- Determined methodologies and procedures for carrying out effective data analysis.
- Assisted organization in performing data compiling, mining, and analysis required to evaluate given data.
- Assisted with Credentialing and Re-Credential Providers as well as Anthem Blue Cross Updates for CA providers.
- Maintained research database, update and upgrade it from time to time and ensure safe storage of data.
- Prepared analysis reports and be responsible to answer any queries, complaints, or suggestions in this regard.
- Streamlined current EFT processes to keep current with business needs.
Operations Supervisor
GYMBOREE DISTRIBUTION CENTER
2007.12 - 2010.05
- Communicated and cooperated with partners and outside vendors.
- Effectively communicated with and supported sales, marketing and administration.
- Recruited and trained staff.
- Ensured that all health and safety guidelines were followed to OSHA standards.
- Supervised and motivated staff and management.
- Reviewed processing schedules and production orders concerning inventory.
- Prepared and maintained production reports and personnel records.
- Established operational objectives and work plans and delegated assignments to subordinate managers.
- Trained, coached and mentored staff to ensure smooth adoption of new program.
- Developed and rolled out new policies.
Education
Associate of Applied Science - Medical Billing And Coding
Asher College
Sacramento, CA2019
Skills
- Workers' compensation knowledge
- Database and Filing Systems
- Records management professional
- Research and Analytical Skills
- Insurance billing and collection procedures expert
- Patient referrals expert
- Medical terminology
- Advanced Knowledge in ICD-10 and CPT
- Employee training and development
- EHR Software
- Account and spreadsheet management
- Knowledge in various medical specialties
- Charting and clinical documentation
- Process Improvement
- Training and Onboarding
- Customer Account Management
- Data Entry and Maintenance
- Operations Management
Additional Information
- US Army Military Police Veteran 2004-2006
- Gaps in employment were due to raising kids and completing my degree
- COVID-19 Vaccinated
Timeline
Insurance Verification Specialist
TEXAS DERMATOLOGY SPECIALISTS
2023.07 - Current
Leasing Specialist
PICERNE REAL ESTATE GROUP
2022.05 - 2023.02
Patient Access & Referral Specialist-Contractor
SUTTER HEALTH VALLEY HOSPITALS
2019.10 - 2022.01
Communications Operator
KAISER PERMANENTE
2018.05 - 2019.01
Patient Care Coordinator
TMS HEALTH SOLUTIONS
2017.03 - 2018.05
Specialty-Referral Coordinator
U.S. HEALTHWORKS MEDICAL GROUP
2015.08 - 2017.01
Assistant Provider Network Specialist
VSP GLOBAL
2014.11 - 2015.08
Operations Supervisor
GYMBOREE DISTRIBUTION CENTER
2007.12 - 2010.05
Associate of Applied Science - Medical Billing And Coding
Asher College
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