Experience

MemorialCare

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Outpatient Utilization Review Assistant

  • Nov 2022 - Present

  Long Beach, California, United States The Outpatient Utilization Review Assistant, using decision trees and standard work, is responsible for a broad range of utilization review support services to ensure efficient authorization coordination including registering patients, eligibility verification, scheduling patient visits, obtaining authorizations, preparing billing data through data entry in EMR and 3rd party billing systems, maintaining patient information through chart documentation in EMR, preparing required reports and… Show more The Outpatient Utilization Review Assistant, using decision trees and standard work, is responsible for a broad range of utilization review support services to ensure efficient authorization coordination including registering patients, eligibility verification, scheduling patient visits, obtaining authorizations, preparing billing data through data entry in EMR and 3rd party billing systems, maintaining patient information through chart documentation in EMR, preparing required reports and providing other support as requested. The Outpatient URA is responsible for selecting appropriate chart documents to submit timely requests to government insurances, private health plans, medical groups and IPAs to secure authorizations and documents activities and authorizations per standard work. The Outpatient URA is able to navigate and understand payer portals for transmission of authorizations.

• Insurance Verifier

  • Dec 2017 - Nov 2022

  Long Beach, California, United States Conducting interviews with patient representing the medical center’s admission and financial policies Obtain demographics and third-party payer information necessary for admission and billing of patient accounts. Compile, verifies, analyzes, and distribute demographic, insurance, and financial information to be used by various hospital departments to assure proper compliance and prompt service to patients; assures verified data. Provide accurate billing of changes and timely collection… Show more Conducting interviews with patient representing the medical center’s admission and financial policies Obtain demographics and third-party payer information necessary for admission and billing of patient accounts. Compile, verifies, analyzes, and distribute demographic, insurance, and financial information to be used by various hospital departments to assure proper compliance and prompt service to patients; assures verified data. Provide accurate billing of changes and timely collection of accounts; supports hospital and departmental. Represents the medical center's admission and financial policies. Obtains demographic and third party payer information necessary for admission and billing of patient accounts; compiles, verifies, analyzes, and distributes demographic, insurance, and financial information to be used by various hospital departments to assure proper compliance and prompt service to patients; assures verified data will provide accurate billing of charges and timely collection of accounts; supports hospital and departmental goals in a manner that will enhance the successful operation of the hospital and create a positive image to the public Make sure all necessary authorizations and approvals in accordance with established guidelines are received.



Regal Medical Group

• United States
• Hospitals and Health Care
• 400 - 500 Employee

• Afterhours Inpatient Coordinator

  • Nov 2018 - Apr 2022

  Downey, California, United States • Discharge planning for admitted patients in acute care and healthcare facilities. • Create referral authorization for inpatient and outpatient services coordinator • Authorizations for Home Health/DME/Hospice/Follow up appointments will be done coordinating with Case Managers. • Request for authorizations will be given via fax/return phone calls. • Monitor campus fax server and process accordingly. • Communicate to Medical Director or designee, immediately any admissions to… Show more • Discharge planning for admitted patients in acute care and healthcare facilities. • Create referral authorization for inpatient and outpatient services coordinator • Authorizations for Home Health/DME/Hospice/Follow up appointments will be done coordinating with Case Managers. • Request for authorizations will be given via fax/return phone calls. • Monitor campus fax server and process accordingly. • Communicate to Medical Director or designee, immediately any admissions to non-contracted hospitals. • All new admissions are to be checked for Out of Area status. • Confirmation of inpatient status of all inpatients will be obtained by 10 am for reporting at morning case rounds. • Assist Inpatient Case Managers with planning for discharge by generating authorizations and scheduling appointments for services needed within 7 days of discharge. • Communicate with High Risk/outpatient department(s) any services identified upon discharge that is necessary beyond 7 days after discharge. • Support the safe, continuous delivery of medically necessary care and supportive ancillary services in the inpatient and transition to home care setting. • Execute all post discharge needs (ie: PCP, Specialist appts, diagnostic studies, etc). • Identify network needs and report to management for potential contracting opportunities. Show less



MemorialCare

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Registration Representative

  • Dec 2015 - Oct 2017

  Long Beach, California, United States The Registration Representative is under the direction of the Supervisor/ Manager and is responsible for completing all registrations of patients presenting for procedures, admissions, outpatient and ER visits. The Representative must obtain and verify demographic and insurance information so that the patient can be accurately identified and billed for their services. The registration representative is responsible for collecting and posting the patients financial responsibility in Epic and… Show more The Registration Representative is under the direction of the Supervisor/ Manager and is responsible for completing all registrations of patients presenting for procedures, admissions, outpatient and ER visits. The Representative must obtain and verify demographic and insurance information so that the patient can be accurately identified and billed for their services. The registration representative is responsible for collecting and posting the patients financial responsibility in Epic and immediately dropping the payment in the safe or locked cash drawer. Excellent customer service must be maintained with all patients, visitors, clinicians, and co-workers. Show less



Los Angeles County Department of Public Health

• Government Administration
• 1 - 100 Employee

• Intermediate Typist Clerk

  • Oct 2004 - Oct 2015

  Los Angeles County, California, United States • Protect the security of medical records to ensure that confidentiality is maintained. • Retrieve patient medical records for physicians, technicians, or other medical personnel. • Plan, develop, maintain, or operate a variety of health record indexes or storage and retrieval systems to collect, classify, store, or analyze information. • Release information to persons or agencies according to regulations. • Process patient admission or discharge documents. • Process and prepare… Show more • Protect the security of medical records to ensure that confidentiality is maintained. • Retrieve patient medical records for physicians, technicians, or other medical personnel. • Plan, develop, maintain, or operate a variety of health record indexes or storage and retrieval systems to collect, classify, store, or analyze information. • Release information to persons or agencies according to regulations. • Process patient admission or discharge documents. • Process and prepare business or government forms. • Compile medical care and census data for statistical reports on diseases treated, surgery performed, or use of hospital beds. • Post medical insurance billings. • Manage the department or supervise clerical workers, directing or controlling activities of personnel in the medical records department. • Prepare statistical reports, narrative reports, or graphic presentations of information, such as tumor registry data for use by hospital staff, researchers, or other users. • Train medical records staff. • Resolve or clarify codes or diagnoses with conflicting, missing, or unclear information by consulting with doctors or others or by participating in the coding team's regular meetings. • Operate telephone switchboard to answer, screen, or forward calls, providing information, taking messages, or scheduling appointments. • Perform administrative support tasks, such as proofreading, transcribing handwritten information, or operating calculators or computers to work with pay records, invoices, balance sheets, or other documents. • Process and prepare memos, correspondence, travel vouchers, or other documents. • Provide information about establishment, such as location of departments or offices, employees within the organization, or services provided. Show less