Raquel Marquez
6100 Mckinley Ave South Gate,Ca
Summary
- Seeking a position as a Financial Counselor which my training and experiences can help increase the client base and growth of the company in an organization that offers the opportunity for growth in an environment that is both challenging and rewarding.
- Pre-Admission Coordinator/Insurance Verifier
- Over 20 years of Patient Registration Experience
- Quality Assurance
- Bilingual in English and Spanish
- Huron On trac Web-Based work listing
- Collaborate with internal and external resources
- Knowledge in CPT, ICD10 Codes/HIPPA Compliance
- Document Coordinator/Detail-Oriented and Organized
- Medical Billing and Collections
- Computer literate (MS word, excel)
- Medical Technology
- Dependable and reliable individual
- Quick to learn and accomplish tasks in a timely manner
- Professional attitude / team player
Overview
24
24
years of professional experience
Work History
Surgery Scheduler
RETINA VITREOUS ASSOCIATES MEDICAL GROUP
Los Angeles, CA
06.2024 - Current
- Created and managed surgical schedules for multiple surgeons.
- Coordinated with patients, staff, and physicians to ensure accurate scheduling of surgeries.
- Provided patient education and answered questions regarding the surgery process.
- Assisted with pre-operative preparation such as obtaining insurance authorizations, lab work, radiology tests.
- Ensured that all required documents were obtained prior to scheduled procedures.
- Conducted follow up calls with patients after their procedure was completed.
- Managed appointment reminders for upcoming surgeries via phone or mailers.
- Maintained a high level of customer service by responding promptly to inquiries from patients and families about their care plans and procedures.
- Worked with operating facilities to schedule procedures on behalf of surgeons.
- Checked patient insurance and collected pre-authorizations from providers.
- Gathered current medical information and reviewed histories to gather details for surgeons.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Collaborated with other hospital personnel to coordinate resources for optimal patient flow during surgery scheduling processes.
Principal Admitting Worker
UC IRVINE MEDICAL CENTER
Orange, CA
10.2023 - 04.2024
- Coordinated with insurance companies to ensure proper coverage of services before admission.
- Verified patient insurance information and obtained authorizations for services from insurance companies.
- Performed data entry tasks to update patient information in the hospital's database systems.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Secure Authorizations for all Out Patient-Surgeries from all Insurance Companies.
- Adhered to establish Departmental policies and procedures related to Insurance verifications.
- Performed verifications of Medicare coverage
- Determined estimated self-pay portion by calculating charges, coinsurance and deductibles
Pre-Admitter Financial Counselor
Good Samaritan Hospital
Los Angeles, California
01.2008 - 10.2023
- Serve as a liaison representative between Physician Surgery Coordinators and Hospital Schedulers to secure patients for In-Patients, Out-Patients, GI Procedures and Cardiology Procedures
- Obtain CPT and ICD-10 codes for all scheduled procedures
- Verify insurance eligibility, Online or via telephone
- Identify Managed Care Insurance Companies and third-party Payers
- Verify if Pre-Certification or Determination is required for all scheduled procedures
- Secure authorizations for all In-Patients and Out-Patients Surgeries from all Insurance Companies
- Call patients to pre-register via telephone
- Prepare and maintain patient insurance information in hospital data base
- Enter patient's personal data into hospital data base and Consultant's data base
- Answer patient's questions on insurance coverage plans or benefit questions
- Work under pressure to secure surgery accounts for next day surgeries or same day add-ons
- Coordinate with Contract Department for Letter of Agreements for non-contracted insurances
- Assisted Financial Counselor on screening uninsured patients for government insurance or charity assistance
- Obtain self-pay quotes for surgery patients
- Obtain contracted insurances reimbursement rates
- Color code patient's financial folders for Patient Access Registration
- Fax hospital notifications of patient's admission to health plans and medical groups
- Obtain tracking numbers from health insurance plans on surgery accounts
- Completeness of 99% of accounts for all patients
- Other duties as needed
- Financial Counseling.
- Monitored changes in health care policies and procedures related to insurance verification process.
- Verified insurance coverage and eligibility for services using computer software.
- Received, analyzed and responded to incoming calls from patients and providers regarding insurance issues.
- Assisted in training new staff on insurance verification processes and procedures.
- Provided customer service support by answering questions regarding benefits, coverage, payment plans.
- Ensured compliance with HIPAA regulations when handling confidential patient information.
- Performed quality assurance reviews on completed work for accuracy and completeness.
- Adhered to established departmental policies and procedures related to insurance verifications.
- Performed verification of Medicare coverage.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Updated patient and insurance data and input changes into company computer system.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
- Created and sent time of service letter to inform patient of estimated self-pay balance.
- Navigated through multiple online systems to obtain documentation.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Determined whether additional documentation was needed to process claims.
Admitting Representative/ER Admitting Representative
East Valley Hospital
Glendora, California
03.2005 - 01.2008
- Pre-Admit surgery cases/OB-GYN
- Financial Counselor
- Insurance verifier (HMO, Medicare, Medi-Cal, Private Insurances)
- Obtain CPT and ICD9 Codes for scheduled procedures
- Obtain Authorizations
- Review patient account files and ensures their accuracy and completeness.
- Assisted in the registration process by obtaining patient demographic information and insurance information.
- Verified insurance eligibility prior to patient admission.
- Processed admissions paperwork accurately and efficiently.
- Maintained confidentiality of all patient records according to HIPAA regulations.
- Provided general administrative support to Admitting Department personnel as needed.
- Performed bed assignments for admitted patients in accordance with departmental policy and procedures.
- Maintained a high level of quality customer service when interacting with patients, families, visitors, and medical staff members.
- Assisted with the collection of payments from patients.
- Provided support during emergency situations within the admitting area.
- Checked patient information and insurance coverage.
- Completed registrations for laboratory work, surgical procedures and radiology.
- Verified patients' insurance and payment methods during admissions or check-in processes.
- Completed registration procedures for patients, expertly inputting information to meet provider, facility and legal requirements.
- Counseled patients on potential financial liabilities and payment requirements.
- Obtained informed consent and payment documentation from patients and filed in system.
Admitting Representative
Ela star Community Hospital (Formerly Santa Marta Hospital)
Los Angeles, California
09.2000 - 08.2004
- Patient Registration/Data Entry
- Insurance verifier Insurance verifier (HMO, Medicare, Medi-Cal, Private Insurances)
- Obtain CPT and ICD9 Codes for scheduled procedures
- Obtain Authorizations
- Review patient account files and ensures their accuracy and completeness
- Switch Board Operator
- Other Duties as assigned.
- Assisted in the registration process by obtaining patient demographic information and insurance information.
- Verified insurance eligibility prior to patient admission.
- Processed admissions paperwork accurately and efficiently.
- Provided general administrative support to Admitting Department personnel as needed.
- Performed bed assignments for admitted patients in accordance with departmental policy and procedures.
- Maintained a high level of quality customer service when interacting with patients, families, visitors, and medical staff members.
- Determined charges and collected co-pays.
- Verified documentation methodically to avoid critical errors impacting care delivery and payments for services.
- Cultivated positive relationships with patients to help facility meet satisfaction scores and patients obtain best possible care.
- Completed registration procedures for patients, expertly inputting information to meet provider, facility and legal requirements.
Education
Bryman College
10.1996
Roosevelt High School
06.1992
Skills
- Customer service experience
- Data Entry and Review
- Eligibility Determination
- Analytical Thinking
- Insurance terminology
- Coverage and Authorizations
- Financial Counseling
- Understanding of medical terms
- Insurance plan verification
- Documentation and Correspondence
- Medical Terminology
- Surgery Scheduling
References
Available on request
Timeline
Surgery Scheduler
RETINA VITREOUS ASSOCIATES MEDICAL GROUP
06.2024 - Current
Principal Admitting Worker
UC IRVINE MEDICAL CENTER
10.2023 - 04.2024
Pre-Admitter Financial Counselor
Good Samaritan Hospital
01.2008 - 10.2023
Admitting Representative/ER Admitting Representative
East Valley Hospital
03.2005 - 01.2008
Admitting Representative
Ela star Community Hospital (Formerly Santa Marta Hospital)
09.2000 - 08.2004
Bryman College
Roosevelt High School
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