Maria E. Email & Phone Number

United States

Responsible for reviewing and prioritizing incoming coverage determination and redetermination requests for Medicare, Commercial, and Medicaid members. Communicate with different departments to ensure adequate members care. Responsible for doing prior authorizations over the phone with doctor’s office and getting all information needed to give their members the prescription coverage they deserve. Assured that prior authorizations were completed in a timely manner. Set up member prior authorization for coverage determination approvals. Made sure the member prior authorization was accurate and performed a test claim. Ensured the claim got accurate rejection and made sure the claim paid or not whether it was approved or denied. Made calls to member’s home or LTC facility to advice of approval or denial prior authorizations. I also worked appeals validation. Reviewed the appeal and initial request, compared the information provided, validated the appeal request was a true appeal, updated the appeal date/time stamp and pushed the appeal to be reviewed. Worked on other special projects as needed such as Independent Review Entity, report worked for anything elapsing in less than 1.5hours that needs completion no matter what queue it was in.

West Sacramento, California

Provided quality health care services to patients from pediatrics to adults. Greeted patients and prepared them for examinations. Obtained patient medical history and vital signs. Assist physician during patient examinations. Performed routine laboratory tests and administered injections. Performed electrocardiograms or other diagnostic tests. Explained treatment procedures, medications, or doctor’s instructions. Stocked and maintained supplies and cleanliness of rooms.

Citrus Heights, California

Providing prescription medication monitoring systems for practices with a high level of customer service.

Fair Oaks, California

I was responsible for many duties many of them which included handling and answering external and internal phone calls, as well as transferring calls. Checking and calling patients insurance to check eligibility. Scheduled appointments and manage patients appointments according to doctors schedule. Fax prescription refill to pharmacy and other documents as requested. Prepare super bill and progress note for each day's visit. Room patients, take and record vital signs which included height, weight, BP, and respiration. I explained procedure to be performed to patient and position patient for the procedure. I also administered injections and diagnostics test. I performed diagnostic and laboratory tests including spirometry, urine dips, and urine HCG.

Roseville, California

Provide front and back office support. Answered multiple phone lines in a professional and courteous manner. Roomed patients, obtained vital signs, and positioned patient for procedure. Ensure cleanliness of facility, exam rooms, and equipment such as instruments.