Yesenia Oliveros
Santa Ana,California
Summary
Successful health information professional accomplished in maintaining complex and comprehensive records systems. Enhanced operations by identifying and recommending upgrades. Fully versed in medical terminology and code classifications.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Business Analyst/Outside Utilization Review
Accenture
Walnut Creek, CA
09.2023 - 12.2023
- Gather/collect patient medical information using client template or questionnaire
- Perform prior authorization requirement validation such as benefits and eligibility
- Submit service request to obtain prior authorization if needed and as directed by nurse partner
- Facilitate referrals as directed by nurse partner
Monitor referral status and perform “next step” actions as directed by nurse partner and/or client protocol - Arrange services post-discharge as directed by nurse partner
Follow up with patient and/or provider post-discharge as directed by nurse partner - Coordinated patient transfers between facilities when medically necessary.
Member Service Representative
Word & Brown
Orange, CA
04.2016 - 09.2023
- Verified customer identification and documentation for compliant transactions
- Assisted members with enrollment, correcting account, service, and system issues by educating on required forms and technical processes
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals
- Learned internal systems and related service role duties to provide skilled team backup in handling customer demands
- Enhanced productivity levels by anticipating needs and delivering outstanding support
- Promptly responded to inquiries and requests from members, employers, brokers, and providers
- Delivered prompt service to prioritize customer needs
- Calculated correct order totals, updated accounts, and maintained detailed records for inventory management
- Processed billing and invoicing with various brokers and groups
- Responded to customer requests, offering excellent support and tailored recommendations to address needs
- Handled complaints with prompt, courteous service to uphold professional reputation.
New Patient Representative
Western Dental
Orange, CA
04.2013 - 07.2015
- Answered patient assistance calls, assessed needs, and offered qualified support
- Educated patients and families on proper care and treatment to facilitate successful home care
- Supported patient admissions, discharges, and transfers to promote team productivity
- Verified any changes or data updates to patient records and checked insurance information at each appointment
- Scheduled appointments for patients and placed reminder calls 48 hours before office visits
- Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery
- Informed patients of excessive wait times and offered to reschedule appointments
- Responded to patient emergencies with immediate care and notified clinicians to provide comprehensive assistance.
Child Caretaker
BHH Respite Services
Lake Forest, CA
02.2013 - 04.2013
- Dispensed snacks and meals to children in accordance with nutritional guidelines
- Used positive reinforcement techniques to promote patience and other good behaviors in children
- Helped children develop motor skills in preparation for preschool and kindergarten
- Introduced children to educational games and activities to boost learning
- Observed play activities to identify positive behaviors and areas in need of improvement, implementing behavior redirection where appropriate
- Created safe and engaging learning environment for groups of diverse children with various learning styles
- Worked with children to develop good cognitive, physical and language skills
- Applied positive behavior management techniques to enhance social interactions and emotional development
- Liaised with parents and guardians to discuss child progress
- Facilitated learning through play, stories and outdoor activities for successful child outcomes.
Education
Cal State Fullerton
11.2012
Communications -
Santiago Canyon College
06.2012
Skills
- Microsoft Office
- Interpretation and Translation Services
- Administrative and Office Support
- Clear Verbal Communication
- Phone Etiquette
- Multitasker and Quick Learner
- Workflow Analysis
- Utilization Review
- Patient Care Plans
Certification
- Health and Life Licence
Languages
English
Professional
Spanish
Professional
References
References available upon request.
Timeline
Business Analyst/Outside Utilization Review
Accenture
09.2023 - 12.2023
Member Service Representative
Word & Brown
04.2016 - 09.2023
New Patient Representative
Western Dental
04.2013 - 07.2015
Child Caretaker
BHH Respite Services
02.2013 - 04.2013
Cal State Fullerton
Communications -
Santiago Canyon College
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