Yvonne Marquez
Chaparral,NM
Summary
Experienced healthcare administration professional specializing in benefits coordination, medical referrals, and prior authorizations. Manages high-volume caseloads while ensuring HIPAA compliance and supporting Medicare and TRICARE beneficiaries. Bridges communication between healthcare providers, clients, and insurance entities to enhance patient care, resolve billing issues, and expedite authorization processes.
Overview
7
7
years of professional experience
Work History
Referral & Authorization Specialist
Kech, Inc.
El Paso, TX
2025.03 - Current
- Coordinate, audit, and expedite comprehensive referral and medical authorization processes for complex TRIWEST claims, ensuring zero lapse in patient continuity of care.
- Interpreted and applied regional insurance policies and medical necessity criteria to secure approvals for diagnostic imaging, specialized surgeries, and outpatient care.
- Liaised with healthcare providers, case managers, and internal teams, auditing clinical documentation for accuracy to eliminate processing bottlenecks and mitigate compliance risks.
- Utilized specialized healthcare databases and EMR software to track claim statuses, resolve authorization discrepancies, and update medical stakeholders and beneficiaries in real time.
Health Benefits Coordinator
GDIT
Las Cruces, NM
2024.03 - 2025.02
- Educated and advocated for Medicare beneficiaries by managing complex coordination of primary and secondary insurance benefits, enhancing access to comprehensive Part D pharmaceutical and prescription drug coverage.
- Investigated, researched, and documented accident- and workers' compensation cases, ensuring third-party liability alignment and accuracy in medical/pharmacy billing processes.
- Managed a high-volume daily caseload within a rapid-response call center environment, consistently exceeding strict federal quality assurance benchmarks, formulary guidelines, and data integrity standards.
- Investigated, researched, and meticulously documented accident- and workers' compensation-related cases, ensuring proper third-party liability alignment and accurate medical/pharmacy billing.
Case Analyst
TEKsolutions
Las Cruces, NM
2023.11 - 2024.02
- Processed complex, time-sensitive human services cases, resolving systemic eligibility disputes and income verification issues to ensure compliance and support timely decision-making.
- Collaborated with cross-functional agency teams to streamline case workflows, evaluate program compliance, and present operational findings to key stakeholders to influence strategic business decisions.
- Processed complex, time-sensitive Human Services cases, identifying and resolving systemic eligibility disputes, income verification issues, and missing verification documentation.
- Maintained digital case files and prepared summaries and reports for administrative review, ensuring audit readiness and facilitating accurate record-keeping.
Substitute Teacher / Paraeducator
Gadsden ISD
Chaparral, NM
2022.03 - 2023.11
- Fostered an inclusive, highly structured classroom environment, implementing individual education programs (IEPs) and behavior plans to maximize student focus, safety, and academic success.
- Delivered adapted, individual instruction across multiple grade levels, tailoring teaching strategies to support diverse learning styles, special education requirements, and exceptionalities.
- Managed classroom documentation, tracked attendance, and logged behaviors, ensuring compliance with district policies and student privacy regulations (FERPA).
Food Service Sanitation Specialist
Blackstone Consikting Incorporated
El Paso, TX
2019.10 - 2021.12
- Conducted regular inspections to maintain compliance with health standards.
- Ensured cleanliness and sanitation of all facilities and equipment.
- Trained new staff on sanitation procedures and safety protocols.
- Documented cleaning activities for compliance and quality assurance records.
- Monitored cleaning supplies and reported inventory needs to management.
Education
High School Diploma - Relevant Coursework
El PasoSkills
- Referral management
- Case Management
- Care Coordination
- Benefits management
- Healthcare Administration
- Compliance
- HIPAA Compliance
- Medical Terminology
- CPT
- ICD-10
- HCPCS
- Data management
- Data
- EMR systems
- Software
- Systems
- Microsoft Office Suite
- Patient Call Management
- Documentation
- Operations
- Client relations
- Data management
Timeline
Referral & Authorization Specialist
Kech, Inc.
2025.03 - Current
Health Benefits Coordinator
GDIT
2024.03 - 2025.02
Case Analyst
TEKsolutions
2023.11 - 2024.02
Substitute Teacher / Paraeducator
Gadsden ISD
2022.03 - 2023.11
Food Service Sanitation Specialist
Blackstone Consikting Incorporated
2019.10 - 2021.12