Veronica Candate
Sacramento,CA
Summary
Seasoned Revenue Cycle Specialist with comprehensive background in medical insurance policies, claims processing and patient advocacy. Demonstrated proficiency in verifying insurance benefits, obtaining pre-authorizations and communicating effectively with healthcare providers. Proven skills in maintaining accurate records, ensuring compliance with regulations and providing exceptional customer service. Previous roles have shown significant improvement in streamlining authorization processes, enhancing operational efficiency and reducing claim denials.
Overview
22
22
years of professional experience
Work History
Insurance Authorization Specialist
RadNet Management Inc.
Sacramento, CA
11.2020 - Current
- Responsible for performing patient registration, insurance and authorization verification, and providing patients with an estimated explanation of their financial responsibility for various Radiological exams.
- Efficiently obtained medical radiological authorizations and provided support for 7 DRI and NorCal (Northern) locations.
- Extensive knowledge of various medical insurance guidelines and authorization processing policies.
- Compassionately guided patients by phone through the authorization process and answering their questions and concerns.
- Coordinate with office staff to ensure timely and accurate scheduling of patients.
- Cross-train and assisted as needed in other departments (l.e. scheduling, front office, etc).
- Participate in various projects and/or meetings, and complete other tasks as assigned by management.
Insurance Services Representative
Surgical Care Affiliates
Sacramento, CA
11.2014 - 10.2020
- Responsible for providing efficient verification of patient insurance eligibility and benefits.
- Extensive knowledge of various medical insurance policies and guidelines to ensure accurate and timely processing of medical claims.
- Ensured that all medical services requiring pre-certification and authorization were obtained prior to exams.
- Maintained a 97% score with accuracy and efficiency data entry of patient demographic and insurance information into Patient Accounting System. My consistent level of speed and accuracy strongly supported my departments and our ability to maintain quarterly revenue goals.
- Responsible for providing efficient Insurance deductible, coinsurance, and co-payment estimates to patients. In addition, provided Financial Patient Counseling.
- Experience with various Insurance payer guidelines and processing of insurance and claims.
- Knowledge of payer contracts including Medicare, Medicaid, and other Government contracts and guidelines and Workmen's Compensation fee schedule.
Lead Customer Service Representative
River City Medical Group
Sacramento, CA
08.2013 - 11.2014
- Responsible for providing exceptional customer service assistance to both patients and various internal medical office staff regarding member coverage and medical authorization status.
- Aided in resolving escalated customer and provider complaints and grievances regarding authorization status.
- In-depth knowledge of the guidelines and policies of Medi-Cal and Geographical Health Medi-Cal based programs.
- Assisted in the hiring and training of Department staff, as well as monitored the daily workflow and assignments of the department employees.
Senior Insurance Service Representative
Dignity Health Care
Sacramento, CA
10.2006 - 08.2013
- Responsible for providing 7 years of superior customer service and assistance to both internal provider staff and patients and providers regarding insurance policy and medical authorization status.
- Consistently maintained department accuracy of 98% or higher monthly production goal with insurance and payer pre-billing accounts.
- Provided quick and efficient data entry skills.
- Efficient multi-tasking skills and ability to process various projects with little error.
- Processed simple and complex Insurance Billing Errors and A/R Reporting issues to ensure accurate ensure clean processing of Claims.
- Promoted to Insurance Services Trainer for the Transformation Care Team which supported all the Northern California Mercy clinical staff in becoming knowledgeable and efficient in verifying and efficiently entering correct Insurance payers in Epic payer system.
Internship Student
Celestial Group Home Services
Sacramento, CA
01.2012 - 03.2012
- Responsible for providing daily Client Living and Developmental skills assistance.
- Also, provided basic English, Reading, and Math tutoring assistance.
- Accountable for monitoring and recording progress and disturbances in behaviors.
Internship Student
UCP of Sacramento and Northern California
Sacramento, CA
04.2011 - 05.2011
- Responsible for assisting the Director of the United Cerebral Palsy with developing a written Proposal for a Peer and Advocacy Program.
- Provided assistance with conducting interviews with clients and supporting family members to help understand and document issues effecting developmental progression.
Internship Student
Sacramento Family Food Bank Services
Sacramento, CA
08.2009 - 10.2009
- Responsible for providing tutoring to bilingual adults and adolescents seeking assistance with Basic English, Reading, and Math skills to obtain a High School Diploma.
- Assisted in food pantry stocking, delivery, and compassionately providing meals to people throughout the community.
- Also, responsible for assisting in Employment Coaching and Resume development for clients.
Psychiatric Medical Assistant
Dr. Laurie J Peters, MD
Sacramento, CA
05.2003 - 10.2006
- Provided efficient and practical scheduling for providers, as well as empathetic initial-patient consultation to patients.
- Responsible for verification of Insurance eligibility and benefits and provided financial estimates to patients for treatment.
- Responsible for obtaining, referrals and authorizations for patient consultations.
- Assisted in the coordination of medical refill request to pharmacies.
- Responsible for processing medical records request and maintaining compliance of medical files and records in accordance with HIPPA Regulations and State Guidelines.
Education
Bachelor of Science - Human Services
UNIVERSITY OF PHOENIX
Sacramento, CA09.2012
Skills
- Experience with various medical, hospital administrative, and EHS software systems
- Insurance verification expertise
- Authorization processing
- Patient registration
- Payer guidelines
- Customer relationship management
- Revenue cycle management
- Financial counseling
- Effective communication
- Problem solving
- Team collaboration
Timeline
Insurance Authorization Specialist
RadNet Management Inc.
11.2020 - Current
Insurance Services Representative
Surgical Care Affiliates
11.2014 - 10.2020
Lead Customer Service Representative
River City Medical Group
08.2013 - 11.2014
Internship Student
Celestial Group Home Services
01.2012 - 03.2012
Internship Student
UCP of Sacramento and Northern California
04.2011 - 05.2011
Internship Student
Sacramento Family Food Bank Services
08.2009 - 10.2009
Senior Insurance Service Representative
Dignity Health Care
10.2006 - 08.2013
Psychiatric Medical Assistant
Dr. Laurie J Peters, MD
05.2003 - 10.2006
Bachelor of Science - Human Services
UNIVERSITY OF PHOENIX
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