Yadira Rodriguez
Summary
Tenacious Referral Specialist with 6 years connecting patients with medical providers. Successful working with insurance companies and other medical professionals to obtain prior authorization and set up essential client appointments. Applies proactive approach to problem-solving and resourceful use of industry network. Professional and knowledgeable office duties offering several years of experience in administrative support and patient care. Attention to details.
Overview
11
11
years of professional experience
Work History
Authorization and Referral Specialist
Optum
09.2017 - Current
- Assisted patients in navigating insurance requirements, facilitating approval for treatments.
- Confirm provider's participation status with patient's insurance plan/networks.
- Provide excellent customer service to patients via phone, fax, email or in-person inquiries.
- Follow up on all outstanding authorizations until they are approved or denied.
- Successfully managed a caseload of over 800 authorizations/referrals per month while meeting all deadlines.
Medical Office Assistant
North Hudson Community Action
04.2015 - 08.2017
- Improved patient satisfaction by efficiently scheduling appointments and managing patient records.
- Enhanced patient care with timely and accurate data entry, prescriptions and lab- results.
- Contributed to a positive work environment by maintaining organized files and facilitating clear communication between staff members.
- Maintained strict compliance with HIPAA regulations, ensuring the confidentiality of sensitive patient information.
- Schedule and confirmed appointments.
Medical Denial Specialist
A.R.M.C.
05.2013 - 04.2015
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Increased overall productivity by implementing efficient denial tracking and follow-up processes.
- Reduced aging accounts receivable balance with timely appeal submissions for denied claims.
- Analyzed denial trends to proactively address recurring issues and improve clean claim submission rates.
Education
Certification - Medical Billing And Coding
Lincoln Technical Institute
Paramus, NJ10.2010
Hemodialysis - Dialysis Technology
Harrison Career Institute - Jersey City
Jersey City, NJ03.2003
High School Diploma -
William L Dickinson High School
Jersey City, NJ06.1993
Skills
- Pre-authorizations, Referrals, Denials
- Manage faxes, emails, telephone
- Follow-up online or via phone with multiple insurances
- EPIC, Word, Excel, Microsoft Teams, Nice, Genesis phones
- Excellent communication skills with peers and patients
- Referral Verification, Eligibility, Prior Authorizations
- HIPAA Compliance
- Analytical Thinking
- Multitasking Abilities
- Medical terminology knowledge
- Healthcare industry understanding
Languages
Spanish
Native or Bilingual
Timeline
Authorization and Referral Specialist
Optum
09.2017 - Current
Medical Office Assistant
North Hudson Community Action
04.2015 - 08.2017
Medical Denial Specialist
A.R.M.C.
05.2013 - 04.2015
Certification - Medical Billing And Coding
Lincoln Technical Institute
Hemodialysis - Dialysis Technology
Harrison Career Institute - Jersey City
High School Diploma -
William L Dickinson High School
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