Veronica Gonzalez-Cervantes
Downey,CA
Summary
Self-motivated, dependable Inpatient Case Management Coordinator & Authorization Coordinator experienced in Utilization Management, advocating and providing great patient services. Demonstrated clinical skills in assessing and obtaining community resources to customize care plans. Commitment and understanding of equal opportunities with diverse and multicultural environments.
Overview
14
14
years of professional experience
Work History
Inpatient Case Management Coordinator
Memorial Care Medical Group
Fountain Valley
01.2022 - Current
- Assessed and identified service delivery challenges and opportunities within local area.
- Established partnerships with local organizations to enhance services.
- Provided hands-on and proactive leadership to community services staff.
- Evaluated program effectiveness through data analysis and feedback.
- Consulted with staff on resolution of complex service issues.
- Maintained compliance with federal, state, and local regulations.
- Coordinated discharge planning to ensure a smooth transition of care.
- Utilized data and experience to coordinate patient care and rehabilitation.
- Provided information to access financial assistance, legal aid or housing.
- Managed daily correspondence, ensuring timely responses and accurate records.
- Operated multiline telephone systems; directed calls to appropriate parties or took messages.
- Processed Patient Authorizations.
- Provided Customer Service.
- Verified Insurance Eligibility
- Provided Translation Services (Bilingual/Spanish)
Member Service Representative/Authorization Coordinator
Aids Healthcare Foundation, AHF
Los Angeles, CA
10.2012 - 07.2021
- Answered phone calls, directed inquiries, and took messages.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Greeted patients warmly and provided excellent service.
- Handled sensitive information with confidentiality and discretion.
- . Managed electronic health record systems accurately.
- Arranged hospital admissions for patients as required.
- . Conducted appointment reminder calls to reduce no-shows.
- Supported administrative staff by distributing correspondence timely.
- Scheduled and confirmed patient appointments and consultations.
- Organized patient files according to HIPAA guidelines.
- . Provided general clerical support including data entry.
- Managed billing, insurance claims, and payment processing.
- Completed relevant insurance and other claim forms.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
Prior Authorization Coordinator
Hispanic Physicians IPA
Los Angeles
01.2010 - 10.2012
- Processed Prior Authorization Requests from Primary Doctors and Specialists.
- Handled sensitive information with confidentiality and discretion.
- Greeted patients warmly and provided excellent service.
- Data Entry
- Verified Insurance Eligibility.
- Provided Translation Services (Bilingual-Spanish)
Education
Certification Received - Medical Billing and Medical Office Administration
American Career College
Los Angeles, CA01-2009
High School Diploma -
John Marshall Senior High School
Los Angeles, CA06-2006
Some College (No Degree) - Medical Social Work
Compton Community College
Compton, CASkills
- Client Advocacy
- Policy Knowledge
- Discharge Documentation
- Regulatory Compliance
- Patient Communication
- Data Collection
- Active Listening
- Service planning
- Written and verbal communication
- Interpersonal Communication
- Professionalism
- Analytical Skills
- Attention to Detail
- Organizational Skills
- Interpersonal Skills
- Written Communication
- Team Collaboration
- Staff Training
- Reliability
- Multitasking
- Time management abilities
- Proficiency in EPIC Medical System
- Proficient in Excel documentation
- Knowledge of EOB's
- Medical Terminology
- Medicare, Medi-cal and HIPAA Guidelines
Timeline
Inpatient Case Management Coordinator
Memorial Care Medical Group
01.2022 - Current
Member Service Representative/Authorization Coordinator
Aids Healthcare Foundation, AHF
10.2012 - 07.2021
Prior Authorization Coordinator
Hispanic Physicians IPA
01.2010 - 10.2012
Certification Received - Medical Billing and Medical Office Administration
American Career College
High School Diploma -
John Marshall Senior High School
Some College (No Degree) - Medical Social Work
Compton Community College
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