Rosely Salazar
Los Banos
Summary
Dedicated healthcare professional with extensive experience in insurance authorizations, referrals, and medical customer service, seeking a role in medical administration. Proven expertise in verifying patient accounts, processing documentation, and collaborating with providers and insurance plans to ensure timely approval and delivery of essential medical equipment and services. Committed to enhancing patient care through efficient administrative support and effective communication, with a strong focus on quality service delivery. A results-driven approach fosters seamless interactions between patients and healthcare providers, ensuring optimal outcomes in every engagement.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Patient Account Representative, Core Operations Team
Cardinal Health
Carlsbad, CA
08.2021 - Current
- Reviewed and worked up to 80 durable medical equipment accounts in a daily basis for medical supplies including Dexcom g7, Freestyle Libre brands, and BGM Meter kit.
- Verified patient demographic information, physician details through phone and email communications.
- Reviewed prescriptions and medical records to ensure accuracy of diagnosis codes, HCPCS codes, product specifications, provider information, NPI information in compliance with insurance requirements.
- Submitted prior authorization requests and referrals to insurance providers
- Verified insurance eligibility, benefits, coverage details, and communicated estimated patient financial responsibility.
- Collected payment information from patients, coordinated insurance billing and shipment processing for DME supplies.
- Communicated with physician offices daily to obtain missing prescriptions, progress notes, and other required documentation via phone and fax.
- Maintained thorough knowledge of insurance guidelines, coverage criteria, and medical record requirements.
- Collaborated with physicians, nurses, and territory business managers to obtain necessary documents for dme shipments, insurance and claims processing approval.
- Managed a high volume inbound, outbound call queue, assisting approximately 80+ patients daily with order status, shipments, insurance questions, and product information.
- Supported sales initiatives by discussing product options, explaining insurance coverage, and providing estimated out of pocket costs for supplies.
Medical Biller Customer Service Support
Zotec Partners
Carmel, IN
01.2021 - 07.2021
- Provide customer service support pertaining to medical billing
- Overview that prior authorizations obtain accurate ICD 10 and CPT coding for proper claim submission
- Assist patients with explaining insurance EOB
- Assist patients with updating and correcting insurance information
Referral Coordinator
Randstad Healthcare Solutions
La Palma
11.2019 - 02.2020
- Obtained prior authorizations for outpatient surgical procedures in accordance with payer guidelines and requirements.
- Reviewed ICD-10, CPT, and HCPCS codes within patient medical records to ensure accurate referral and authorization submissions through healthcare portals.
- Requested and collected clinical documentation from physician offices to support referral reviews and establish medical necessity.
- Communicated authorization approvals and denials to members, providing timely updates and addressing questions as needed.
- Processed referrals from primary care providers and specialty physicians efficiently while maintaining compliance with organizational and payer standards.
Referral Coordinator
Coast Health Care Management
Cypress, CA
06.2018 - 07.2019
- Reviewed and processed prior authorizations and referrals and accurately coded Cpt procedure codes and ICD-10 Diagnosis code.
- Requested clinical medical notes from referring specialist office, if not included attached in authorization for proper medical review.
- Contacted Members insurance health plan if necessary for accurate benefits check
- Provided timely notification of urgent authorization approvals and denials to members, clearly explaining decision outcomes, coverage guidelines, and eligibility requirements.
- Initiated daily reports to gather all work that conclude incoming Urgent, Inpatient, outpatient authorizations.
- Accurately reviewed and documented patient account details, ensuring timely follow-up and appropriate progression of account activities
Referral Coordinator
Community Health Care of Washington
03.2018 - 07.2018
- Processed high volume of prior authorizations and referrals.
- Review and correct cpt procedure and diagnosis codes if needed for compliance and reimbursement accuracy.
- Supervised 6 referral coordinator colleagues in the department of OBGYN, DME, Oncology, Perinatology, home health, ENT and hospital inpatient visits.
- Review and verify that medical records and prescriptions have the correct cpt procedure and diagnosis codes if needed for compliance and reimbursement accuracy.
- Coordinated with physician and specialty offices to secure missing medical documentation necessary for timely authorization processing.
- Supported departmental operations standards and meeting referral and authorization turnaround time requirements.
Prior Authorizations Coordinator
Rosetta Genomics
Lake Forest, CA
09.2016 - 02.2018
- Processed and submitted Pathology Laboratory Genetic Testing Authorizations to Patient’s healthcare carrier.
- Identified problems in daily workflow and takes the initiative to solve them.
- Review and Code medical cpt procedure services and Diagnosis codes based on clinical review and medical history.
- Submitted medical claims to insurance companies and payers.
- Contacted ordering physicians for medical records, progress notes that support necessity of laboratory testing.
- Faxed medical records, progress notes to patient’s health plan for review and approval.
Education
Bachelor of Science - Health Care Administration And Policy
Arizona State University
Tempe, AZ08.2027
Medical Billing and Coding Diploma - ACCSC accredited
UEI College
El Monte, CA01.2009
High School Diploma - NOCE
North Orange County Community College
Cypress, CA2019
Skills
- Bilingual English Spanish
- Patient Relations
- ICD 10 coding
- HCPCS Coding
- DME processing
- Diagnosis review
- Medical Records Review
- Prior Authorizations
- Insurance verification
- Strategic Planning
- Multitasking
Certification
HIPAA Certified
Languages
English
Spanish
Timeline
Patient Account Representative, Core Operations Team
Cardinal Health
08.2021 - Current
Medical Biller Customer Service Support
Zotec Partners
01.2021 - 07.2021
Referral Coordinator
Randstad Healthcare Solutions
11.2019 - 02.2020
Referral Coordinator
Coast Health Care Management
06.2018 - 07.2019
Referral Coordinator
Community Health Care of Washington
03.2018 - 07.2018
Prior Authorizations Coordinator
Rosetta Genomics
09.2016 - 02.2018
Bachelor of Science - Health Care Administration And Policy
Arizona State University
Medical Billing and Coding Diploma - ACCSC accredited
UEI College
High School Diploma - NOCE
North Orange County Community College