Open To Work
Stephanie Castaneda
Work Preference
Summary
Results-driven Medical Authorizations Specialist with 18 years of experience in managing prior authorizations, eligibility verification, and appeals to facilitate timely patient care. Expertise in payer communication, clinical documentation management, and workflow optimization. Committed to enhancing authorization processes to improve patient access and reduce delays.
Overview
18
18
years of professional experience
Work History
Patient Service Representative - Authorizations
Central Maine Medical Center
Lewiston
09.2022 - Current
- Requested preauthorization for all Gastroenterology procedures while assisting with surgeries, sleep studies, and imaging to secure approvals and minimize scheduling delays.
- Coordinated with clinical teams to resolve authorization issues, effectively reducing patient wait times for procedures.
- Resolved insurance denials to ensure timely claims processing and maintain revenue flow.
- Conducted insurance verification and checked for necessary pre-authorizations.
- Maintained detailed patient authorization records and updated insurance data to improve scheduling accuracy.
- Worked high volumes of work accurately and efficiently.
- Submit clinical information along with requests
- Perform other duties as assigned.
- Trained in additional areas to ensure seamless coverage.
Authorization Coordinator
MEDSR
Lewiston
03.2022 - 09.2022
- Coordinated prior authorization requests with payers to secure approvals before procedures, reducing authorization delays.
- Maintained accurate authorization records and status updates, enhancing team visibility and follow-up.
- Collaborated with healthcare teams to ensure timely authorizations, enhancing patient care delivery and minimizing service delays.
- Resolved complex authorization denials by researching policy and submitting appeals, securing approvals for patient care.
- Maintained accurate authorization records and status updates, improving team visibility and follow-up efficiency.
- Streamlined authorization processes, improving approval turnaround times and enhancing patient satisfaction.
- Worked as contract employee at Central Maine Medical Center
Financial Counselor-Patient Access Department
Loma Linda University Medical Center
Murrieta
01.2011 - 04.2021
- Provide financial Information to patients needing assistance.
- Verifying insurance and obtaining authorizations for all Inpatients and ER admitted pts.
- Notified insurance companies and medical groups of inpatient admissions and obtained authorizations.
- Verify insurance for scheduled surgeries or radiology outpt/inpt admissions.
- Resolved insurance denials by collaborating with relevant stakeholders to ensure timely patient access to care.
- Collaborated with case managers and social workers on patient information and discharge planning.
- Audit all inpatient accts, insuring correct payors are chosen on each account and correct patient info entered.
- Followed up on insurance authorization requests.
- Collaborated with health advocates to assess inpatient costs for cash patients, ensuring access to necessary financial resources.
- Notifying patients of inpatient copays prior to scheduled procedures.
- Screening pts for Community or County programs that offer healthcare.
Insurance Verification Coordinator
Fallbrook Hospital
Fallbrook
01.2008 - 01.2010
- Streamlined insurance verification process to reduce pre-authorization delays and improve patient intake efficiency.
- Communicated coverage and out-of-pocket responsibilities to patients, increasing upfront collections and payment arrangements.
- Entered eligibility and authorization data accurately into system to support timely procedure approvals and billing continuity.
- Coordinated with clinical departments to resolve authorization issues, minimizing procedure cancellations and ensuring smoother scheduling.
- Provided backup support for admitting and financial counseling, maintaining department workflow during high-volume periods.
- Managed admitting department operations
Education
GED Program -
La Puente/Hacienda Adult School
01.2000 - 01.2000
Admin Asst. Program -
El Dorado College
High School -
El Monte High School
Some College (No Degree) -
El Monte Adult School
10.1991 -
Skills
- Experienced with EHR
- Insurance verification
- CPT Codes
- ICD-10 standards
- Data entry
- Multi-line phone management
- Microsoft Office Suite
- Navigating multiple websites
- Typing speed 55-60 wpm
- Detail-oriented
- Team player
References
- Valerie Mercado, Loma Linda University Med Ctr Murrieta, mercado96@yahoo.com, (951) 294-2634
- Nicole Pelletier, Central Maine Medical Center, pelletni@cmbc.org, (207) 576-1020
Timeline
Patient Service Representative - Authorizations
Central Maine Medical Center
09.2022 - Current
Authorization Coordinator
MEDSR
03.2022 - 09.2022
Financial Counselor-Patient Access Department
Loma Linda University Medical Center
01.2011 - 04.2021
Insurance Verification Coordinator
Fallbrook Hospital
01.2008 - 01.2010
GED Program -
La Puente/Hacienda Adult School
01.2000 - 01.2000
Some College (No Degree) -
El Monte Adult School
10.1991 -
Admin Asst. Program -
El Dorado College
High School -
El Monte High School