Trinidad Trini Gomez

*Answer in-bound calls on phone queue

*assist and educate members medicaid members on benefits

*pcp change

*order id card for members

*Coordinate transportation for members to doctor's appointments

*educate members on care gaps/metrics

• Handle between 50-75 inbound calls daily through a phone queue
• Effectively oversee and manage the continuum of the new patient referral process within department standards.
• Provides strong customer service to patients and internal and external stakeholders as the clinic's first point of contact.
• Independently assesses patient needs to prioritize and triage referrals.
• Answers phone calls, takes messages and responds to routine patient, physician, and client inquiries.
• Proactively follows-up on missing medical records and test results from referring providers.
• Obtains patient demographic, insurance, referral, and other pre-visit required information.
• Verifies and registers patient accounts in the practice management system.
• Facilitates insurance benefit and eligibility investigations.
• Provides patients with appointment details such as time, location, directions, and instructions to patients.
• Distributes appropriate medical forms to the patient for completion prior to initial visit.
• Maintains and updates physician schedules ensuring that patients are scheduled appropriately.
• Works in conjunction with the clinical team to accommodate scheduling requests.
• Accurately documents/updates patient records in designated systems to ensure all parties have accurate information.
• Provides support and information to providers to problem solve and manage complex administrative issues.
• Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations.
• Other duties as requested or assigned.
• Remote
• Coordinated new patient intake processes to ensure seamless onboarding and scheduling efficiency.

• Answered/Initiated up to 60 incoming and outgoing calls per day
• Scheduled appointments, re-direct calls as appropriate, assist callers with questions or concerns, and take messages as needed
• Returned calls to patients and pharmacies
• Processed acute patients and helped triage calls
• Managed medical records (maintains, files/scans, prepares for schedule)
• Greeted patients as they arrive and manages wait time
• Completed check-in and check-out tasks to include insurance verification
• Completed 20-25 pre authorizations and/or precertification of procedures, and copy required documents
• Collected co-payments, co-insurance, and deductibles and issued receipts
• Managed cashier box and daily deposits according to company policies
• Ensured all correspondence is scanned and/or filed, processed requests for medical records release and maintained appropriate logs, etc.
• Established and maintained effective working relationships with patients, employees, and the public
• Ran reports for manager on a daily basis focus on care/HCC reports

• Maintained accurate surgical schedule for surgeons as outlined in company/department standards and guidelines.
• Communicated with patients regarding:
• Prepared surgical packets and scheduled outpatient procedures at hospitals
• Financial Responsibilities for In-network/Out of network charges if PFS is unable to do this
• Completing notice of exclusion from Medicare/Health Plan benefits for non covered services
• Financing options
• Return all patient phone calls within 4 hours.
• Maintain communication with patients and properly document all conversations as outlined in company standards and guidelines.
• Contacts facilities for scheduling as outlined in company standards and guidelines.
• Arranges for pre-op testing as needed as outlined in company standards and guidelines.
• Schedules pre-op visits as outlined in company standards and guidelines.
• Verified insurance and obtained authorization commercial insurance as well as Medicare/Medicaid gather historical medical information, they take measurements and perform ancillary tests that provide the doctor with the information needed to arrive at a diagnosis and to prescribe treatment. assist with documentation and patient services. perform diagnostic test and assist with in-office procedures.