Mariana Aldana
Lowell
Summary
Dependable Prior Authorization Specialist with extensive experience in managing administrative tasks in high-pressure environments. Bilingual professional skilled in resolving issues and efficiently obtaining prior authorization information for patients. Proven ability to adapt to new challenges and deliver results.
Overview
7
7
years of professional experience
Work History
Prior Authorization Specialist
Brigham and Women Hospital
Boston
07.2022 - Current
- Responsible for reviewing and processing requests for authorization of medical services in accordance with company policies and procedures. Collects and accurately enters information required by third parties for precertification for procedures, tests, and imaging. Notifies the appropriate departments of insurance information, and obtains and inputs corrected insurance information as needed.
- Facilitated prior authorization requests for medical services and procedures.
- Work as part of a group to secure insurance authorizations in an appropriate time frame. Collects and accurately enters information required by third parties for precertification for procedures, tests, and imaging.
- Research and ensure that proper and accurate diagnosis and procedure codes are assigned.
- Refer patients to financial counseling, as appropriate. Inform the patient of authorization concerns prior to admission/procedure, coordinating with appropriate parties to facilitate authorization as appropriate, and collaborating with other departments/offices to resolve complex authorization issues. Code the authorization status in the system and complete the workflow.
- Research and remedy denials, while escalating complex denials.
- Respond to internal and external inquiries regarding authorization decisions, and provide explanations as needed.
- Communicated with healthcare providers to gather necessary patient information.
- Coordinated with insurance companies to verify coverage and approval processes.
- Reviewed medical documentation to ensure compliance with insurance guidelines.
Clinical Administrative Coordinator II
Cambridge Health Alliance
Everett
11.2021 - 07.2022
- Coordinated patient appointments and managed scheduling for multiple healthcare providers.
- Assisted in maintaining accurate patient records within electronic health record systems.
- Facilitated communication between patients and clinical staff to ensure care continuity.
- Managed incoming correspondence, directing inquiries to appropriate departments promptly.
- Supported billing and insurance verification processes for patient
- Scheduled appointments in accordance with facility calendar and provider availability.
- Processed patient data documents, reports, and case management files to assist clinical staff operations.
- Maintained a clean and organized work environment to ensure efficient workflow processes.
- Optimized customer health services, handling clinical admission, personnel assignments, departmental transfers, and discharges.
- Performed administrative tasks such as filing, photocopying, data entry, and record keeping.
- Coordinates imaging, surgery, new patient appointments, diagnostic testing, and procedures with respective teams and departments.
- Managed administration of patient benefits and services according to state and federal guidelines.
- Handled incoming phone calls from patients and responded to inquiries accordingly.
- Collaborated with clinical team members regarding administration and filing for patient referrals and service authorization.
- Triaged patients for clinical coverage, prioritizing most-essential patient care needs.
- Managed patient flow and directed nurses and doctors to ensure medical assignments are completed on time.
Patient Coordinator II
Mass General Hospital
Everett
10.2018 - 11.2021
- Coordinated patient scheduling and managed appointment logistics for multiple departments.
- Assisted patients in completing necessary forms and understanding procedures.
- Communicated with medical staff to ensure timely patient care and support.
- Maintained accurate patient records using electronic health record systems.
- Handled patient inquiries and provided information about services offered.
- Organized follow-up appointments and ensured continuity of care for patients.
- Trained new staff on office procedures and patient coordination best practices.
- Answered incoming calls from patients, providers, and insurance companies in a courteous manner.
- Ensured all paperwork related to patient care was completed accurately and timely.
- Managed medical records by filing documents into appropriate folders according to established protocols.
- Coordinated patient appointments and maintained appointment schedule.
- Pulled patient files and verified insurance before patient's appointment.
- Processed referrals from primary care providers for specialist consultations or treatments.
- Provided support to patients regarding insurance coverage, payment plans, and other financial matters.
- Collected patient data and documented records of health condition, hospitalizations and lifestyle patterns.
- Developed and implemented patient intake forms to ensure accurate information was collected.
- Mentored new hires, including explaining hospital policies, procedures, and practices.
- Responsible for greeting patients as they arrive for appointments, as well as completing patient check-in and check-out processes in a timely manner.
- Verifies patient identity upon the patient's initial check-in by using two patient identifiers.
- Checks the patient's insurance type, comparing what is listed on the insurance card and what is listed in the EPIC system.
- Collects patient co-payments.
Temp Patient Coordinator
Mass General Hospital
Boston
09.2018 - 10.2018
- Coordinated patient appointments and managed scheduling conflicts effectively.
- Schedule appointments and assist with the scheduling of any additional testing directed by the physician.
- Ensure that all required referrals are obtained, scanned into the EMR, and linked to that day's appointment within Practice Management.
- Enter patient demographics into the system.
- Scheduling follow-up procedures and coordinating any local ASC cases, lab tests, surgical procedures, etc.
- Ensure provider productivity by maintaining physician calendars, professional meetings, and consultations.
- Excellent organizational, time management, and strong computer skills.
- Processes medical records requests.
- Scan the documents.
- Provided support to patients regarding insurance coverage, payment plans, and other financial matters.
- Maintained inventory of medical supplies and equipment used in providing patient care.
- Scheduled evaluations and procedures for patients.
- Processed patient intake information and updated medical records prior to treatment.
- Received and routed care team messages and documents to appropriate staff.
Education
High School Diploma -
Everett High School
Everett05-2014
Skills
- Insurance verification
- Medical coding
- Electronic health records
- Prior authorization processing
- Patient communication
- Appointment scheduling
- Clinical coordination
- Problem solving
- Time management
- Team collaboration
- Workflow optimization
- Data entry
- HIPAA compliance
- Precertification requirements
- Benefit coverage
- CPT coding
- Retro-authorizations
- Outpatient/ Inpatient surgery coding
- Patient referrals
- Records maintenance
- Medical coding expertise
- Insurance information oversight
- ICD-10 coding
- Healthcare compliance
Languages
Spanish
Full Professional
Timeline
Prior Authorization Specialist
Brigham and Women Hospital
07.2022 - Current
Clinical Administrative Coordinator II
Cambridge Health Alliance
11.2021 - 07.2022
Patient Coordinator II
Mass General Hospital
10.2018 - 11.2021
Temp Patient Coordinator
Mass General Hospital
09.2018 - 10.2018
High School Diploma -
Everett High School
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