Ana Lopez Tovar

• Coordinated referrals, prior authorizations, and insurance verification for high-risk obstetric and specialty services.
• Verified insurance eligibility, benefits, and coverage while obtaining timely authorizations from commercial and Medi-cal payers.
• Tracked authorizations, followed up on pending requests, denials, appeals, and authorization extensions to ensure continuity of care.
• Reviewed medical records, physician orders, and supporting documentation to facilitate accurate referral and authorization processing.
• Schedule new and follow-up appointments while coordinating care between patients, providers, and outside

facilities.

• Maintained accurate documentation in the electronic health record and ensured HIPAA compliance.
• Answered multi-line phones, assisted patients, and routed messages to providers and clinical staff.

• Served as the first point of contact for patients, delivering exceptional customer service in a high-volume OB/GYN practice.
• Verified insurance eligibility, benefits, and requirements to ensure timely patient care.
• Educated patients on insurance benefits, including maternity coverage, copays, deductibles, coinsurance, out-of-pocket costs, and financial responsibility.
• Collected and maintained accurate patient demographic, insurance, and financial information to support billing and claims processing.
• Maintained and updated electronic health records (EHR), including hospitalizations, specialist consultations, and clinical documentation.
• Communicated patient information to providers to support efficient clinical workflows and quality patient care.
• Processed patient payments, reconciled account balances, and assisted patients with billing and insurance-related questions.
• Trained and mentored new front desk staff on patient registration, appointment scheduling, insurance verification, HIPAA compliance, and office workflows to ensure consistent, high-quality patient service.
• Maintained strict compliance with HIPAA regulations while safeguarding patient confidentiality.

• Verified insurance eligibility and obtained prior authorizations for gynecological procedures, diagnostic testing, imaging, referrals, and specialty services, ensuring timely access to patient care.
• Processed, tracked, and followed up on prior authorization requests, approvals, denials, appeals, and authorization extensions while collaborating with providers, patients, and insurance carriers.
• Requested, retrieved, and reviewed medical records, laboratory results, imaging reports, and specialist documentation from outside healthcare facilities to support referrals, authorizations, and continuity of care.
• Organized and incorporated external medical records into patient charts, ensuring providers had complete documentation for review, signature, and clinical decision-making.
• Maintained accurate, confidential patient records and processed medical record requests in compliance with HIPAA regulations and organizational policies.