Nashaly Torres
South Hadley
Summary
Health services coordinator with proven experience in navigating member care, managing healthcare programs, and ensuring regulatory compliance. Strong focus on team collaboration and achieving results. Adept at handling administrative tasks, provider and member communication, and resource allocation. Known for flexibility and reliability in meeting changing needs
Overview
9
9
years of professional experience
Work History
Health Services Coordinator
Health New England
06.2023 - Current
- Maintain accurate records of all coordinated activities, ensuring proper billing procedures were followed consistently across the department.
- Introduce electronic tools to streamline documentation processes, increasing staff efficiency in managing patient records.
- Promote a positive work environment by fostering open communication and teamwork among colleagues.
- Maintain productivity standards for authorization entry, letter generating, and auditing.
- Pre-screens criteria-based procedures before directing to clinical reviewer.
- Adheres to CMS guidelines.
- Provides support and education to Member Services, Provider relations, and Sales Departments including but limited to researching and resolving complex issues.
- Provides education on criteria-based procedures to members and physicians.
- Makes outbound calls to members to educate them on benefit information.
- Performs review for out-of-network referrals for applicable plans using set guidelines.
- Coordinates and authorizes services based on entitled benefits, defined criteria and set guidelines.
- Primary resource and contact for providers relating to service requests.
- Maintain daily quota of entering 30+ authorizations.
Referral Coordinator
Holyoke Health Center
11.2022 - 05.2023
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Scheduled appointments with specialists on behalf of clients.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Weighed patient need, provider availability and insurance coverage to determine optimal scheduling.
- Completed up to 40 referral requests each day for medical provider of specialty services.
- Acted as main point of contact for patients, doctors and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
- Worked with patients to schedule tests and procedures.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Utilized EPIC to complete referrals for specialty services.
Order Fulfillment Specialist
Insight Global-Eppendorf TEMP
03.2022 - 09.2022
- Handled and processed biotech orders via email and SAP systems
- Used Excel to update weekly open order report
- Answered, screened, and forwarded over 30 emails daily
- Kept up with time sensitive shipping dates to ensure customer satisfaction
- Created deliveries on orders that were fully in stock
- Handled and received payments for orders depending on customer's payment contract
- Created Warranty Replacement orders for orders that have been lost or damaged in process of shipping
- Checked inventory and selected products from specific locations based upon availability.
- Alternated goods in inventory by observing first-in and first-out approach to keep shelves organized and properly stocked.
- Followed orders precisely for correct items, sizes and quantities.
- Prepared and checked outbound shipments for accuracy.
Centralized Scheduling Coordinator
Holyoke Medical Center
05.2021 - 03.2022
- Obtained prior authorizations from health insurances to ensure smooth billing process
- Responsible for indexing doctor’s orders, data entry, and patient information management
- Answered, screened and forwarded incoming calls to appropriate staff/department
- Handled patient referrals alongside with different departments/doctor’s offices
- Conducted hospital discharge follow-up calls in timely manner
- Scheduled 40+ specialty appointments for patients daily
- Requested order corrections from doctor’s offices for quality control purposes
- Obtained missing orders for scheduled appointments to prevent cancellation
Administrative/Rental Agent Assistant
Mount Holyoke Management
12.2019 - 05.2021
- Answered, screened and forwarded over 50 incoming phone calls to relevant staff
- Scheduled monthly meetings and appointments with relevant staff
- Scheduled notices to tenants for annual inspections and pest control
- Ordered and maintained stock of office supplies
- Ordered and maintained work orders
- Prepared documents for Property Manager and Rental Agent for appointments with tenants
- Directed incoming and outgoing mail/packages to appropriate staff
- Requested and completed work orders from tenants
- Greeted visitors in office
- Maintained tenant and work order files organized.
Seasonal Warehouse Associate
United Personnel
08.2019 - 11.2019
- Prepared and packaged Yankee Candle Fundraiser Catalogs
- Quality controlled incoming and outgoing orders of Yankee Candle Fundraiser Catalogs
- Prepared orders for shipment by systematically picking, packing and labeling merchandise.
- Inspected incoming and outgoing shipments to verify accuracy and prevent errors.
- Cleaned and maintained warehouse in compliance with OSHA safety standards.
- Manually or mechanically loaded and unloaded materials from pallets, skids, platforms, cars, lifting devices, or other transport vehicles
- Shipped Yankee Candle Fundraiser orders
- Packaged an average of 450 Yankee Candle Fundraiser orders daily.
Direct Care Specialist
Pathlight Group
10.2018 - 09.2019
- Recorded and maintained the individuals’ information
- Reported daily in the corresponding binder of each individual
- Documented any behavioral changes of the individuals using daily behavior charts or ABC charts
- Met nutritional guidelines specialized to each and every individual with every meal of the day
- Answered phone calls and direct visits within the individuals’ residency
- Responsible for administering medication if MAP certified
- Ensured the privacy of the individuals’ medication records
- Provided direct care such as bathing, dressing, and grooming
- Established a great support system to ensure the well being of the individuals.
- Helped with home management tasks, meal preparation, grocery shopping and routine cleaning.
- Kept clients engaged in social networks and communities for personal health and growth.
- Remained alert to problems or health issues of clients and competently responded.
- Provided safe mobility support to help patients move around personal and public spaces.
Home Health Aide
Compassionate Healthcare Systems
04.2016 - 04.2019
- Recorded and maintained patient information
- Document patient's progress by completing weekly timesheets, weekly tasks assigned in a personalized care plan, and report to the client’s nurse when necessary
- Assisted patients with scheduling their appointments
- Ensured that clients take their daily doses of medication
- Provided direct care such as bathing, dressing, and grooming.
- Traveled to clients' homes to complete healthcare services and promote continuity of care.
- Provided mobility assistance such as walking and regular exercising.
- Provided transportation and appointments management.
Volunteer Front Desk Clerk
River Valley Counseling Center
08.2018 - 10.2018
- Greeted visitors and customers upon arrival, offered assistance and answered questions to build rapport and retention.
- Sorted incoming and outgoing mail
- Responsible for making copies of important documents used everyday
- Answered multi-line phone system to respond to inquiries and transfer calls to correct departments and personnel.
- Maintained files and records by implementing effective filing systems that boosted efficiency and organization.
- Reminded clinicians and medical case managers of their appointments with their clients.
Education
Certificate - Foundations of Health
Holyoke Community College
05.2020
High School Diploma -
Springfield Central High School
06.2017
Skills
- Detail Oriented
- Great team player
- Excellent interpersonal and communication skills
- Proficient in Neutral Writing/Reporting
- Experience in keeping confidential/medical records
- Proficient in Microsoft Excel and Microsoft Word
- Confidentiality Requirements
- Patient Registration
- Medical Terminology
- Customer Support
- Insurance Verification
- High-Volume Environments
- Patient Referral
- Remote work
- HIPAA
- Healthcare management
- Quality improvement
- Healthcare compliance
- Prior authorizations
Languages
Spanish
Native or Bilingual
Timeline
Health Services Coordinator
Health New England
06.2023 - Current
Referral Coordinator
Holyoke Health Center
11.2022 - 05.2023
Order Fulfillment Specialist
Insight Global-Eppendorf TEMP
03.2022 - 09.2022
Centralized Scheduling Coordinator
Holyoke Medical Center
05.2021 - 03.2022
Administrative/Rental Agent Assistant
Mount Holyoke Management
12.2019 - 05.2021
Seasonal Warehouse Associate
United Personnel
08.2019 - 11.2019
Direct Care Specialist
Pathlight Group
10.2018 - 09.2019
Volunteer Front Desk Clerk
River Valley Counseling Center
08.2018 - 10.2018
Home Health Aide
Compassionate Healthcare Systems
04.2016 - 04.2019
High School Diploma -
Springfield Central High School
Certificate - Foundations of Health
Holyoke Community College
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