Emely L. Barahona
Lomita
Summary
Highly organized and solution-oriented professional with a passion for continuous learning and productive work. Seeking a position in a stimulating and challenging environment to leverage abilities, skills, and experience for the success of the company. Committed to fully utilizing potential while actively contributing to the growth and achievement of the organization.
Overview
6
6
years of professional experience
Work History
CONCURRENT REVIEW COORDINATOR
Healthsmart MSO
04.2023 - Current
- Run discharge report every morning & notify the hospitals to confirm admission status for each patient
- Notify Case Managers of any discharges along with disposition
- Gather all proper paperwork for authorization processing and approval for all obstetrics cases (i.e
- Baby weight, Apgar scores, time of delivery, type of delivery)
- Process inpatient authorizations and forward all tracking numbers to the corresponding Case Manager
- Follow DOFR and confirm admission is not subject to Out-of-area with patient’s health plan
- Properly file and distribute incoming faxes to the assigned coordinator
- Ensure to update and run weekly report of assigned IPA with the correct providers
- Responsible to run eligibility the first of the month for SNF and any acute inpatient members
BILLER /PAYMENT POSTER/ INSURANCE VERIFIER/ BILLING CONCIERGE
La Peer Health Systems
10.2022 - 04.2023
- Responsible to obtain all final operative reports from providers and upload to the system (Egnyte) for coding
- Check Egnyte daily for coded operative reports
- Input bill charges and bill claims to appropriate payers (via paper or electronically)
- Monitor and manage weekly report of missing provider dictations
- Responsible to bill patients and providers alike for cash/ non-insurance cases
- Follow up with provider and coders for corrections
Payment Poster
La Peer Health Systems
04.2021 - 04.2023
- Track all incoming payments and pull their corresponding EOB/ EFT
- Accurately post all payments (e.g., insurance, patient, & misc
- Payments) in a timely matter
- Ensure adjustments are accurately recorded in each individual account
- Ensure to properly notate accounts and forward EOBs to the appropriate Collector
- Balance all posted batches and generate a batch summary report for accounting
- Daily scanning and filing of all complete batches into system to their corresponding posting dates
- Process insurance and patient refund requests
- Meet the month end closing deadlines as set by the company
Insurance Verifier Specialist
La Peer Health Systems
01.2020 - 04.2023
- Responsible to obtain correct patient demographic information
- Verify upcoming and incoming patient’s eligibility and benefits
- Advise supervisor of any possible coverage issues & ensure to forward ABN forms when necessary
- Familiarize the center’s schedule and ensure to review at least 2 weeks in advance
- Consistently stay up to date with any schedule changes throughout the day/week
- Ensure to notify the provider’s office and/or initiate pre-authorizations when required
- Review insurance’s policies and requirements for specific procedures
- Notate verified accounts with their accurate benefit information
- Utilize various software's and systems (e.g
- HST, Waystar, Experior, Availity, Noridian)
- Accurately calculate patient’s out of pocket costs as based on their benefits and procedures
- Notify patients when their COB needs updating in order to avoid future claim denials and delays
Billing Concierge
La Peer Health Systems
07.2019 - 04.2023
- Call and notify patients of their out-of-pocket costs in a timely manner
- Answer any patient’s questions they may have about their costs or coverage/ benefits
- Ensure patient’s information/ demographics are accurately entered into the system
- Upkeep cancellations, monthly collections, and initiate payment plans
- Notify scheduling of any cancellations while pre-registering patients
- Provide quotes for provider’s offices upon request
- Collect patient’s payments over the phone or provide link to payment portal
- Offer patients discounts or payment plans options to save their case
- Ensure constant and proper communicate with the front desk and all departments during check in to avoid any issues
Receptionist
La Peer Health Systems
01.2019 - 07.2019
- Answer phones & accurately provide information and direct calls to the appropriate staff
- Check-in patients and verify identification & insurance cards
- Review patient’s accounts for any pending necessary information
- Ensured to collect accurate Out-of-pocket costs at check-in as noted
- Responsible to notify both PACU coordinators and patients of any OR delays
- Ensure all pathology was sent out to the appropriate labs
- Assemble patient’s medical charts and gather accurate documentation
- Properly highlight patient’s paperwork and ensure to input patient’s cost/payments in their medical chart
Education
High School Diploma -
Palisades Charter High School
Palisades, CA06.2013
Skills
- Bilingual (Spanish and English)
- Team-Player
- Excellent communication skills
- Knowledge of medical terminology
- Familiarity with HIPPA
- Motivated self-starter
- Driven to acquire new skills
- Detailed Oriented
- Problem Solver
- Proficient computer skills
- Microsoft Word
- Outlook
- Excel
- Ability to work with several operating systems
- Windows
- Mac OSX
- Productivity & Time Management
Timeline
CONCURRENT REVIEW COORDINATOR
Healthsmart MSO
04.2023 - Current
BILLER /PAYMENT POSTER/ INSURANCE VERIFIER/ BILLING CONCIERGE
La Peer Health Systems
10.2022 - 04.2023
Payment Poster
La Peer Health Systems
04.2021 - 04.2023
Insurance Verifier Specialist
La Peer Health Systems
01.2020 - 04.2023
Billing Concierge
La Peer Health Systems
07.2019 - 04.2023
Receptionist
La Peer Health Systems
01.2019 - 07.2019
High School Diploma -
Palisades Charter High School
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