Krisbel Santibanez
Oxnard
Summary
Compassionate professional in healthcare patient relations, known for high productivity and efficient task completion. Possess specialized skills in conflict resolution, patient advocacy, and health information privacy practices. Excel at communication, empathy, and problem-solving to enhance patient satisfaction and support healthcare objectives.
Overview
10
10
years of professional experience
Work History
Patient Access Representative
Adventist Health Systems
Roseville
10.2018 - 08.2025
- Managed high-volume inbound and outbound calls to schedule imaging services, verify insurance, and complete pre-registration for radiology patients.
- Processed 40-50 radiology authorizations daily across PPO, HMO, and other insurance plans, ensuring approvals met payer-specific guidelines and turnaround requirements.
- Contacted physician offices to obtain required clinical documentation and confirm medical urgency for time-sensitive exams.
- Verified insurance eligibility, determined prior authorization requirements, and confirmed medical necessity to prevent claim denials and care delays.
- Submitted authorization requests through payer portals and EMR systems (e.g., Epic, Cerner, Facets, Availity) with 99%+ accuracy.
- Educated patients and providers on pre-exam requirements, coverage limitations, and authorization processes, improving understanding and reducing repeat inquiries.
- Collaborated with radiology departments, scheduling teams, and providers to coordinate services, avoid appointment disruptions, and ensure a seamless patient experience.
- Maintained HIPAA compliance and met or exceeded departmental productivity, quality, and turnaround time goals.
Referral Specialist I
Anthem, INC
Glendale
08.2021 - 05.2022
- Managed 70-80+ inbound calls daily from providers, members, and internal care teams, processing referrals and prior authorizations for surgical procedures and behavioral health services.
- Conducted eligibility verification, benefit checks, and utilization management reviews to expedite approvals and prevent treatment delays.
- Reviewed clinical documentation, coding, and provider contracts to ensure compliance with NCQA standards, HIPAA regulations, and Anthem guidelines.
- Collaborated with surgeons, behavioral health specialists, case managers, utilization review nurses, and facilities to resolve documentation issues and coordinate care.
- Educated providers and members on referral processes, coverage criteria, network restrictions, and appeals, reducing repeat inquiries by 25%.
- Maintained 98-100% accuracy in data entry and referral processing using Anthem systems such as Facets, Availity, and internal CRM platforms.
- Partnered with care coordination and population health teams to fast-track urgent cases, including crisis-level behavioral health interventions.
Appointment Scheduler
Change Healthcare
Newbury Park
08.2015 - 09.2018
- Scheduled patient appointments for NYU Langone Health providers across multiple specialties, ensuring accurate provider, location, and service selection.
- Handled high-volume inbound calls from patients and referring providers, booking appointments in compliance with NYU Langone scheduling protocols.
- Verified insurance eligibility, confirmed referral and authorization requirements, and communicated pre-appointment instructions to patients.
- Coordinated with clinical staff to secure urgent or time-sensitive appointments, improving patient access to care.
- Documented all appointment details and patient interactions in the EMR system (Epic) with 99%+ accuracy.
- Educated patients on appointment preparation, required documentation, and follow-up procedures, reducing no-show rates and rescheduling needs.
- Maintained HIPAA compliance and consistently met departmental call handling, scheduling accuracy, and productivity benchmarks.
Education
High School Diploma -
Frontier High School
06.2013
Skills
- Business process improvement
- Data Entry
- Software expertise
- Adaptability
- Time Management
- Cross functional collaboration
- Bilingual In Spanish
- Healthcare Compliance
- Phone etiquette
- Typing speed and accuracy
- Conflict Resolution
Timeline
Referral Specialist I
Anthem, INC
08.2021 - 05.2022
Patient Access Representative
Adventist Health Systems
10.2018 - 08.2025
Appointment Scheduler
Change Healthcare
08.2015 - 09.2018
High School Diploma -
Frontier High School