Vanessa Perez
Beecher,IL
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for behavioral health services. Detail-oriented performer with over 5 years of managing documentation in healthcare. Considered team player with exemplary multitasking skills.
Overview
5
5
years of professional experience
Work History
Prior Authorization Specialist
Franciscan Physician Network
01.2023 - Current
- Follow payer processes (website, fax, contact number) to submit appropriate clinical documentation. Remain current on updates from payers to ensure appropriate reimbursement from payers.
- Serve as primary resource to ambulatory clinics regarding the prior authorization process and requirements.
- Collect clinical information regarding services to be rendered for prior authorizations.
- Contact payers to obtain prior authorizations. Enter standardized documentation within electronic medical record to identify prior authorization and the criteria surrounding each authorization.
- Educate providers and their clinical staff regarding the prior authorization process. Advise providers and their clinical staff when issues arise relating to obtaining prior authorization.
- Primary resource to patients regarding prior authorization process.
- Verify that all insurance requirements have been met.
Medical Assistant
Dermio Dermatology
08.2022 - 01.2023
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Obtained client medical history, medication information, symptoms, and allergies.
- Performed medical records management, including filing, organizing and scanning documents.
- Assisted with routine checks and diagnostic testing by collecting and processing specimens.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Helped improve patient outcomes by educating and advising on relevant treatments and care.
Prior Authorization Specialist
HealthPCP
12.2020 - 06.2022
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
Certified Nursing Assistant
ManorCare Health Services-Hinsdale
07.2018 - 08.2019
- Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
- Promoted good oral and personal hygiene by aiding patients with shaving, bathing, and teeth brushing.
- Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
- Cared for residents in assisted living facility and delivered high-quality support to meet needs.
- Completed activities of daily living for patients unable to self-care, and assisted those with limited mobility in completing tasks.
- Documented patient information and care activities in electronic health record.
Education
Bachelor of Science - Nursing
Governors State University
University Park, IL05.2027
No Degree - Medical Assisting
Prairie State College
Chicago Heights, IL08.2022
High School Diploma -
Dwight D. Eisenhower
Blue Island, IL05.2018
Skills
- Laws and Regulations
- Medicare/Medicaid
- Patient Billing
- Documentation and Record Keeping
- Insurance Processes
- Changing Priorities
- Adaptability
- Concentration
- Verbal & Written Communication
- Multitasking
- Patient advocacy
Languages
Spanish
Native or Bilingual
Timeline
Prior Authorization Specialist
Franciscan Physician Network
01.2023 - Current
Medical Assistant
Dermio Dermatology
08.2022 - 01.2023
Prior Authorization Specialist
HealthPCP
12.2020 - 06.2022
Certified Nursing Assistant
ManorCare Health Services-Hinsdale
07.2018 - 08.2019
Bachelor of Science - Nursing
Governors State University
No Degree - Medical Assisting
Prairie State College
High School Diploma -
Dwight D. Eisenhower
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