Sandra Rivera

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Patient Support Specialist

Hello Alpha

Dec 2024 - Current (1 year 8 months)

Review and process prior authorization requests for medications, procedures, and treatments in compliance with insurance requirements. Communicate with insurance companies, providers, and patients to facilitate the timely approval of services and treatments. Track the status of pending authorizations and follow up as needed to avoid delays in patient care. Collect, organize, and maintain accurate medical records for provider review, ensuring all relevant patient history, lab results, and clinical notes are included. Coordinate with internal departments and external entities to obtain any missing records or documents necessary for patient care. Respond promptly to support queue items including voicemails, patient inquiries, and other care-re

Virtual Medical Assistant

BruntWork

Sep 2024 - Dec 2024 (4 months)

Answer phone calls and communicate with patients and other callers. Schedule, reschedule and manage patients appointments. Check and respond emails. Verify insurance cards and check patient eligibility. Enter patient data and manage electronic records. Handle general administrative tasks related to medical office operations.

Referral Coordinator

Ascension Health

Dec 2021 - Mar 2023 (1 year 4 months)

Confirms insurance coverage via payer portals and determines necessity for pre-authorization. Obtains authorization and processes referrals for services ordered by providers. Schedules appointments as appropriate and within required timeframes and assuring referrals are maintained within appropriate network and/or payer requirement. Communicates with patients, healthcare providers, and third-party service providers regarding insurance coverage and barriers to care. Documents detailed information in the patient medical record, and any actions taken regarding authorization status, coverage issues, restrictions and appointment details. Notifies patients and providers of services requested that are not authorized by insurance.

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Coordinator Physician Office Billing – Cardiology

Amita Health – Resurrection Medical Center

Sep 2020 - Dec 2021 (1 year 4 months)

Organize and Coordinates the activities and flow of work for billing and collections functions. Schedules and confirm appointments, and inputs customer data into company systems. Oversees patient access activities including pre- registration, insurance verification, patient registration, patient check in and check out, upfront collection, billing and medical records, and provides general administrative assistance to providers. Assist patients with meeting their financial obligations regarding co-pays, coinsurance and deductibles. Evaluates documentation to ensure that appropriate, accurate, and complete information is maintained and appropriate authorizations are obtained. Remains current on specific changes and requirements related to vari

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Lead Rep Patient Access - Pain Clinic

Amita Health - Resurrection Medical Center

Nov 2016 - Sep 2020 (3 years 11 months)

Working directly with insurance companies to verify insurance coverage, benefits and obtain authorizations. Estimation of patient's financial responsibility and hold financial discussions with patients, and family members regarding collections of copay, financial obligations, initiating payment arrangements, and identifying financial assistance needs. Coordinates and deliver verbal and written information regarding insurance denials for patients and providers with the proper insurance company. Performed duties under minimal supervision and followed moderately complex procedures and guidelines. Proficient with medical terminology that helps me to provides support for physicians and nursing staff to expedite our daily workflow, while ensuring

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Registrar Patient Access

Presence Health Resurrection Medical Center

Oct 2015 - Nov 2016 (1 year 2 months)

Meet and greet patients. Check daily schedules for patient information updates. Registration of patients, scan and update patient information, demographic and insurance information into the patient's permanent records within the hospital system. Work with multiple departments regarding patients scheduled procedures. Secures signatures, witnesses and explains conditions of admission forms (Consents for treatment, Hippa, etc.). Arranges payment agreements. Requests payments, prior balances and co-payments. Reviews and processes physician orders as well ordering and preparing patients paperwork for test/surgery.

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Admissions Associate

Kindred Chicago Healthcare

Jul 2012 - Oct 2015 (3 years 4 months)

Provide administrative support for patient's hospital admission documents and consents. Provide information on admission polices/procedures to patients, and family members. Insurance verifications. Maintains files and conducts special projects as assigned. Prepares Census Reports, death certificates and outside procedure forms. Assist in answering phone inquires by taking messages and forward to appropriate department.

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