Marisol Guzman-Fuentes
Santa Maria
Summary
Experienced in healthcare settings with a focus on insurance verification and authorization processing. Demonstrated ability to maintain accurate documentation in electronic health records while ensuring compliance with HIPAA regulations. Collaborated effectively with various departments to enhance customer service and resolve issues related to patient authorizations. Proven track record of managing multiple tasks efficiently, including scheduling surgeries and coordinating patient communications.
Driven and motivated with a desire to work closely with both customers and coworkers. Proficient at proofreading with excellent customer service skills.
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Medical Authorization Clerk
Central Coast Orthopedic Medical Group
Santa Maria
09.2022 - Current
- Researched payer websites to obtain authorization forms and guidelines.
- Acted as a liaison between providers, billing staff, and insurance companies.
- Identified trends in denied or delayed authorizations and suggested solutions.
- Assisted management with special projects as needed.
- Maintained accurate documentation in electronic health records system.
- Collaborated with other departments when necessary to provide excellent customer service.
- Processed incoming authorizations, denials, and requests for additional information.
- Reviewed and verified patient information to ensure accuracy of data entry.
- Ensured all pre-authorization documents were completed properly prior to submission.
- Analyzed claim denials and worked with appropriate personnel to resolve them.
- Maintained confidentiality of patient information at all times according to HIPAA regulations.
- Communicated with providers regarding authorization status and other related issues.
- Followed up on pending authorizations to ensure timely approval or denial.
- Verified insurance eligibility for patients seeking medical treatment.
- Monitored changes in payer policies that could affect procedures or reimbursement rates.
- Responded promptly to customer inquiries via phone or email.
- Maintained high level of professionalism when speaking to doctors and insurance companies.
- Made outbound calls to insurance companies, patients and physicians to perform eligibility checks for patients.
Surgery Scheduler
Associated surgeons of San Luis Obispo
Pismo Beach
11.2021 - 09.2022
- Communicated with ancillary departments on patient's behalf during the entire pre-operative process.
- Adhered to HIPAA guidelines when handling confidential information.
- Attended weekly meetings with department managers in order to review progress of surgical scheduling operations.
- Processed payments from patients for surgical services rendered.
- Reviewed daily reports on pending cases, cancellations, and no shows in order to make adjustments as needed.
- Assisted with pre-operative preparation such as obtaining insurance authorizations, lab work, radiology tests.
- Created and managed surgical schedules for multiple surgeons.
- Verified accuracy of billing information prior to submitting claims.
- Managed appointment reminders for upcoming surgeries via phone or mailers.
- Coordinated with patients, staff, and physicians to ensure accurate scheduling of surgeries.
- Gathered current medical information and reviewed histories to gather details for surgeons.
- Checked patient insurance and collected pre-authorizations from providers.
- Booked surgeries according to physician volume and maintained prompt turnaround times.
- Coordinated work processes and routed paperwork to appropriate physicians and staff members.
- Scheduled follow-up appointments as designated by physician.
Receptionist
Dignity Health
Santa Maria
04.2015 - 04.2020
- Organized travel arrangements for staff members including flights, hotels, car rentals.
- Coordinated with vendors for repairs and maintenance of office equipment.
- Answered incoming calls, took messages, and transferred calls to appropriate departments or personnel.
- Scheduled appointments for clients, customers, and other visitors.
- Performed data entry tasks into various computer systems accurately and promptly.
- Maintained a neat reception area by organizing materials and tidying up furniture.
- Verified visitors' identification cards before allowing access to the building.
- Greeted visitors and provided them with assistance.
- Scheduled and confirmed appointments and meetings for management team.
- Answered and directed incoming calls using multi-line telephone system.
- Answered, screened, and forwarded incoming phone calls while managing multi-line telephone systems.
- Utilized office equipment such as printers, copiers, and fax machines, ensuring they were in good working order.
- Performed clerical duties such as filing, photocopying, transcribing, and faxing.
- Scheduled and confirmed appointments.
- Processed payments and updated accounts to reflect balance changes.
Education
High School Diploma -
Santa Maria High School
Santa Maria06-2011
Skills
- Insurance verification
- Authorization processing
- Electronic health records
- Customer service
- Data entry
- Documentation accuracy
- Problem solving
- Communication skills
- Time management
- Attention to detail
- HIPAA compliance
- Insurance verification expertise
- Prior authorization
- Healthcare regulations
- Professionalism and ethics
- Clerical support
- Reliability
- Self motivation
- Multitasking Abilities
- Clerical Work
- Adaptability and flexibility
- Goal setting
Languages
Spanish
Professional
Certification
- Pediatric/Adult CPR certified
- Mandated reporter certified
References
References available upon request.
Timeline
Medical Authorization Clerk
Central Coast Orthopedic Medical Group
09.2022 - Current
Surgery Scheduler
Associated surgeons of San Luis Obispo
11.2021 - 09.2022
Receptionist
Dignity Health
04.2015 - 04.2020
High School Diploma -
Santa Maria High School