Yamel Guzman
Lorain,OH
Summary
Results-driven Insurance Authorization Specialist with a proven track record in streamlining authorization processes and ensuring HIPAA compliance. Expertise in conflict resolution and critical thinking enhances operational efficiency and drives positive patient outcomes.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Insurance Authorization Specialist
Ensemble Health Partners
Cincinnati, OH
11.2010 - Current
- Streamlined insurance authorization processes to enhance efficiency and reduce turnaround times.
- Collaborated with healthcare providers to resolve authorization issues and ensure compliance with guidelines.
- Analyzed authorization trends to identify areas for process improvement and implement strategic solutions.
- Secure necessary authorizations for medical services, procedures, and treatments from insurance providers and relevant entities.
- Review patient records and treatment plans to determine authorization needs and verify coverage.
- Accurately complete and submit thru authorization forms, payor portals or thru an insurance phone call, ensuring all required information is provided.
- Monitor pending or denied authorizations, providing additional documentation or appealing decisions as necessary.
- Kept accurate records of all authorizations and related communications to ensure transparency and compliance.
- Kept up with changes in regulations, policies, and procedures related to authorizations to ensure compliance.
- Served as a liaison between patients, healthcare providers, and insurance companies, addressing any issues or delays in the authorization process.
- I also have experience in insurance verifications, collection of copays, deductibles, etc. Scheduling radiology procedures and obtaining radiology diagnostic imaging authorizations. I am currently doing heart surgery authorizations.
- I am currently remote as of Feb 2019.
Education
Medical Assistant Certificate - General, Allied Health And Nursing
Lorain County Community College
Elyria, OH06-1997
High School Diploma -
Lorain High School
Lorain, OH06-1993
Skills
- Prior authorization for diagnotic procedures and heart surgery procedures
- Strong communication skills
- HIPAA compliance
- Active listening
- ICD-10 coding
- Professionalism and ethics
- Conflict resolution
- Documentation management
- Medical billing
- Software navigation proficiency
- CPT coding proficiency
- Medical terminology proficiency
- Critical thinking
- Retro-authorizations
- Patient scheduling
- Data entry
- Insurance verification
- Workflow management
- Knowledgeable in Epic / Microsoft 365, Teams, Windows, Edge, Excel, One Drive, Internet
- Precertification requirements
Certification
- Medical Assistant Certificate
- Certified Revenue Cycle Representative (CRCR)
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Insurance Authorization Specialist
Ensemble Health Partners
11.2010 - Current
Medical Assistant Certificate - General, Allied Health And Nursing
Lorain County Community College
High School Diploma -
Lorain High School