VANESSA ROCHA
Alice,TX
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
21
21
years of professional experience
Work History
Insurance Verification/Authorization Specialist
Humpal Physical Therapy
01.2019 - Current
- Full Time Employee- 40 hours a week
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Tracked referral submission during facilitation of prior authorization issuance.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Developed and maintained productive working relationships with healthcare providers.
- Processed patients lacking coverage for planned procedures.
- Checked documentation for accuracy and validity on updated systems.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Processed and recorded new policies and claims.
- Calculated adjustments, premiums and refunds.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Modified, updated and processed existing policies.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Communicated verification and authorization status updates with billing department to facilitate decision-making for patient admissions and insurance coverage.
- Coordinated with contracting department to resolve payer issues.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Managed multi-line phone system and pleasantly greeted patients.
- Checked patient insurance, demographic, and health history to keep information current.
- Helped patients complete necessary medical forms and documentation.
- Organized paperwork such as charts and reports for office and patient needs.
- Maintained current and accurate medical records for patients.
- Supported office staff and operational requirements with administrative tasks.
- Completed patient referrals to other medical specialists.
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
- Notified manager of incidents and potential incidents relating to patients and staff for swift action.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Performed various administrative tasks by filing, copying and faxing documents.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Obtained payments from patients and scanned identification and insurance cards.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
- Assisted with medical coding and billing tasks.
- Completed data entry tasks with accuracy and efficiency.
- Organized, sorted, and checked input data against original documents.
- Sorted documents and maintained organized filing process.
- Responded to customer concerns and questions on daily basis.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Monitored changes in coding regulations to provide recommendations for compliance.
Provider
American Medical
07.2016 - 01.2019
- Full time employee- 35 hours a week
- My Client was my 89 year old grandmother
- Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
- Assisted disabled clients to support independence and well-being.
- Assisted patients with personal requirements for housekeeping and grooming assistance.
- Cooked tasty, nourishing meals for patients to promote better nutrition.
- Provided patients with assistance in completing daily tasks, reducing daily burden on family members.
- Kept close eye on behavior and emotional responses of clients to address concerns and protect each person from harm.
- Helped clients maintain optimal health by overseeing medication administration and doctor's appointments.
- Interacted kindly with patients and families and displayed positive, outgoing attitude, resulting in establishment of long-term, professional relationships.
- Administered medication as directed by physician.
- Assisted patients with self-administered medications.
- Helped patients safely transition between sleeping surfaces and mobility assistance such as wheelchairs by providing consistent support.
- Established nutritious meal plans and prepared daily offerings to meet patient dietary needs.
- Assisted patients with handling daily chores and errands by transporting to appointments, cleaning personal spaces, and purchasing supplies.
- Performed laundry, grocery shopping and other light housekeeping duties as instructed by client.
- Provided mobility assistance such as walking and regular exercising.
- Provided transportation and appointments management.
- Encouraged patients to participate in safe physical activity to help boost mood and improve overall wellness.
- Developed individual care plans for clients based on specific needs.
Insurance Verification/Authorization Specialist
Humpal Physical Therapy
07.2013 - 04.2016
- Full time employee- 40 hours a week
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Tracked referral submission during facilitation of prior authorization issuance.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Developed and maintained productive working relationships with healthcare providers.
- Processed patients lacking coverage for planned procedures.
- Generated, posted and attached information to claim files.
- Checked documentation for accuracy and validity on updated systems.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Processed and recorded new policies and claims.
- Calculated adjustments, premiums and refunds.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Modified, updated and processed existing policies.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Communicated verification and authorization status updates with billing department to facilitate decision-making for patient admissions and insurance coverage.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Managed multi-line phone system and pleasantly greeted patients.
- Checked patient insurance, demographic, and health history to keep information current.
- Helped patients complete necessary medical forms and documentation.
- Organized paperwork such as charts and reports for office and patient needs.
- Maintained current and accurate medical records for patients.
- Supported office staff and operational requirements with administrative tasks.
- Completed patient referrals to other medical specialists.
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
- Notified manager of incidents and potential incidents relating to patients and staff for swift action.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Performed various administrative tasks by filing, copying and faxing documents.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Obtained payments from patients and scanned identification and insurance cards.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Prepared and processed patient referrals and transfer requests.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
- Assisted with medical coding and billing tasks.
Sales Representative
Flexi Compras
08.2010 - 08.2011
- Full time employee- 40 hours a week
- Managed customer accounts to secure customer satisfaction and repeat business.
- Trained and mentored new sales representatives.
- Retained excellent client satisfaction ratings through outstanding service delivery.
- Developed and maintained comprehensive understanding of products, services and competitors to enhance sales presentations.
- Developed and implemented sales strategies to increase profits.
- Used customer insights to develop innovative sales strategies to increase sales.
- Met with existing customers and prospects to discuss business needs and recommend optimal solutions.
- Generated weekly and monthly reports on sales performance to provide recommendations to meet sales goals.
- Generated new leads through networking and attending industry events.
- Negotiated contracts with clients and developed relationships with key personnel.
- Built relationships with customers and community to promote long term business growth.
- Set and achieved company defined sales goals.
- Gained customer trust and confidence by demonstrating compelling, persuasive and composed professional demeanor.
- Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas.
- Greeted customers and offered assistance with selecting merchandise, finding accessories and completing purchases.
- Negotiated prices, terms of sales and service agreements.
Rehabilitation Technician
Dr Vaughn Chiropractic Clinic
03.2006 - 03.2007
- Full time employee- 40 hours a week
- Established collaborative relationships with patients through consistent and meaningful communication.
- Communicated back to nurses and therapists regarding patient performance and condition.
- Transferred, moved and ambulated patients to and from departments with wheelchairs and stretchers.
- Followed all HIPAA rules and regulations regarding patient confidentiality.
- Maintained cleanliness and sanitation of clinic or treatment environment.
- Prepared for sessions by setting up patient treatment areas and equipment.
- Checked physical therapy supplies, assisting with ordering and restocking.
- Demonstrated proper body mechanics and patient handling techniques for patient transfers and positioning.
- Utilized gait belts, lifts, or slings to safely move and transfer patients.
- Assisted physical therapists with patient examinations using manual therapy techniques and therapeutic exercise instruction.
- Performed therapeutic massage, hot-cold packs placement, or electrical stimulation under direction of physical therapist.
- Monitored patient progress and reported changes to physical therapist.
Physical Therapy Technician
Humpal Physical Therapy
12.2002 - 12.2005
- Full time employee- 40 hours a week
- Monitored patient's safety and response to exercise intensity to discuss with therapist or assistant.
- Assisted with reception duties like scheduling patients and completing follow up calls.
- Prepared patients to meet with physical therapists.
- Executed interventions of modalities or exercise as directed by therapist or assistant.
- Inventoried supplies and ordered more for office and patient rooms.
- Determined therapies, requested materials and received equipment in accordance with patient care initiatives and insurance plans.
- Issued individualized home exercise programs to patients and verified comprehension of instructions before discharge.
- Administered routine exams and treatment for patients.
- Maintained cleanliness and sanitation of clinic or treatment environment.
- Prepared for sessions by setting up patient treatment areas and equipment.
- Scheduled patient appointments to meet treatment requirements and provide quality care.
- Checked physical therapy supplies, assisting with ordering and restocking.
- Assisted physical therapists with patient examinations using manual therapy techniques and therapeutic exercise instruction.
- Followed all HIPAA rules and regulations regarding patient confidentiality.
- Monitored patient progress and reported changes to physical therapist.
- Performed therapeutic massage, hot-cold packs placement, or electrical stimulation under direction of physical therapist.
- Educated patients and families on exercises and proper body mechanics.
- Demonstrated proper body mechanics and patient handling techniques for patient transfers and positioning.
- Utilized gait belts, lifts, or slings to safely move and transfer patients.
- Administered ultrasound, diathermy or other therapeutic modalities.
- Developed and facilitated patient specific stretching and strengthening programs.
- Utilized aquatic therapy treatments for patients with orthopedic and neurological conditions.
Education
Bachelor of Science - Healthcare Information Management
Western Governors University
Salt Lake City, UT2026
High School Diploma -
Agua Dulce High School
Agua Dulce, TX05.2003
Skills
- Authorization Verification
- Outpatient Procedures
- Benefit Coverage
- Confidential Records Management
- Prior Authorization Processing
- Medical Terminology
- Medical Coding
Additional Information
I have been married to a United States Marine Corps Veteran for almost 20 years, So I am Very passionate about our service men and women's healthcare.
Timeline
Insurance Verification/Authorization Specialist
Humpal Physical Therapy
01.2019 - Current
Provider
American Medical
07.2016 - 01.2019
Insurance Verification/Authorization Specialist
Humpal Physical Therapy
07.2013 - 04.2016
Sales Representative
Flexi Compras
08.2010 - 08.2011
Rehabilitation Technician
Dr Vaughn Chiropractic Clinic
03.2006 - 03.2007
Physical Therapy Technician
Humpal Physical Therapy
12.2002 - 12.2005
Bachelor of Science - Healthcare Information Management
Western Governors University
High School Diploma -
Agua Dulce High School
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