Sandy Barbosa
Avon
Summary
Experienced in prior authorization within healthcare, ensuring accuracy of patient insurance information and securing necessary approvals for medical procedures. Strong administrative skills in documentation management and effective communication with patients, providers, and insurance companies. Recognized for problem-solving abilities and precision in task completion, contributing to improved workflow efficiency. Proficient in handling denied claims, ensuring hospitals and providers receive reimbursement for services previously denied due to missing information.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Practice Assistant, Sr
Brigham & Women's Hospital Pain management
Chestnut Hill
10.2024 - Current
- Processed prior authorization requests for scheduled procedures with various insurance companies.
- Conducted detailed investigations to resolve discrepancies in authorization requests.
- Educated patients regarding insurance policies and authorization processes.
- Verified patient insurance coverage, including eligibility benefits and authorizations.
- Scheduled peer-to-peer reviews for physicians to discuss medical necessity of treatments.
- Contacted insurance carriers to secure authorization notifications and pre-certifications.
- Monitored changes in insurance policies to ensure compliance with authorization requirements.
- Managed denial claims work queue, collaborating with billing department on securing retro prior authorizations.
Managed Care Coordinator
BIDMC / Arnold Pain Management Center
Brookline
03.2017 - 10.2024
- Coordinated and processed all specialty care referral authorizations per contractual agreements with managed care payers.
- Utilized electronic technologies to efficiently initiate and sign off on high volumes of referrals.
- Maintained proficiency in electronic systems for timely initiation of referral requests.
- Served as primary contact for patients, families, physicians, and support staff regarding managed care issues.
- Communicated authorization details to specialists and patients, clarifying levels of care and diagnostic testing approvals.
- Resolved referral management issues through effective communication with managed care payers and internal departments.
- Trained new hires on referral management processes to enhance team capabilities.
- Managed denial claims work queue, securing retro prior authorizations for rendered services in collaboration with billing department.
Administrative Assistant II
BIDMC / Arnold Pain Management Center
Brookline
04.2016 - 03.2017
- Managed telephone calls and emails, answering live calls and triaging as needed.
- Scheduled, rescheduled, and canceled appointments while accommodating patient and provider needs.
- Processed prescription calls from patients and pharmacies efficiently.
- Checked emails hourly, responding to all parties and closing communication loops.
- Collected insurance and demographic data from patients accurately.
- Processed patient messages to providers, ensuring closure of communication loops.
- Made 24-hour reminder calls for all new appointments.
- Coordinated scheduling of procedural and follow-up appointments with triage nurse.
Patient Representative
BIDMC / Arnold Pain Management Center
Brookline
12.2013 - 04.2016
- Conducted check-in registration and verification of demographic and fiscal information per medical center policies.
- Confirmed prior authorizations, referrals, and pre-certifications for patient insurance and managed care plans.
- Collected required co-payments in accordance with standards, directing patients to subsequent service areas.
- Processed patient check-out schedules for follow-up appointments and related diagnostic or lab tests.
- Provided relevant educational materials to patients as indicated during visits.
- Entered visit billing tickets accurately into hospital computer systems.
Member Service Representative
Dell, Inc. / Commonwealth Care of MA
09.2009 - 12.2012
- Delivered positive, effective customer service to enhance client satisfaction.
- Managed daily inbound and outbound calls to address customer needs.
- Assisted members with health plan enrollments to ensure smooth transitions.
- Responded to general inquiries regarding billing, enrollment, and eligibility.
Member Service Representative
Blue Cross Blue Shield
Quincy
04.2007 - 07.2009
- Delivered exceptional customer service to all members consistently.
- Assisted internal and external customers via incoming and outgoing calls.
- Utilized BCBSMA computer system to research accounts and adjust medical claims.
- Investigated and resolved member inquiries through correspondence and computer research.
- Advised customers on policy details and benefits for multiple health plans.
- Coordinated internal activities to resolve inquiries and provide effective service solutions.
- Contributed to team efforts to meet or exceed service production and quality goals.
Education
Some College (No Degree) - Medical Billing And Coding
Quincy College
Quincy, MA09-2015
Medical Administrative Assistant -
Lincoln Tech Allied Health
Somerville, MA10.2013
High School -
Revere High School
Revere, MA06.2002
Skills
- Interpersonal dynamics and ethics
- Medical law and HIPAA compliance
- Anatomy and physiology I and II
- Office suite proficiency
- Health information systems management
- Medisoft and Medcin expertise
- Health administration and records management
- Billing and reimbursement processes
- Medical terminology knowledge
- Clinical health management strategies
- Advanced keyboarding proficiency
- Vital signs assessment
- Bartending certification
- Referral coordination
- Claims management
- Prior authorization processing
- Medical necessity evaluation
- Insurance verification
- Healthcare compliance
- Effective communication
- Problem solving
- Attention to detail
- Conflict resolution
- Team collaboration
- Training and mentorship
Languages
- Fluent in Portuguese
- Portuguese Creole
- Spanish
Professional Skills Training
- Interpersonal Dynamics and Ethics
- Medical Law and HIPAA Training
- Anatomy and Physiology I & II
- Office Suite (Word, Excel, PowerPoint, Outlook)
- Health Information Systems
- MediSoft & Medcin
- Health Administration and Records Management
- Billing and Reimbursement
- Medical Terminology
- Clinical Health Management
- Advanced Keyboarding Skills
- Vital Signs
- Bartending Certification
Internship
Boston Medical Center, Boston, MA, Patient Access Representative 1, 09/13, 10/13, Arrived Patients, Scheduled walk-in appointments, Registered Patients, Verified Health Insurance, Filed charts
Languages
English
Professional
Portuguese
Professional
Spanish
Professional
Certification
Medical Administrative Assistant certificate
References
References available upon request.
Timeline
Practice Assistant, Sr
Brigham & Women's Hospital Pain management
10.2024 - Current
Managed Care Coordinator
BIDMC / Arnold Pain Management Center
03.2017 - 10.2024
Administrative Assistant II
BIDMC / Arnold Pain Management Center
04.2016 - 03.2017
Patient Representative
BIDMC / Arnold Pain Management Center
12.2013 - 04.2016
Member Service Representative
Dell, Inc. / Commonwealth Care of MA
09.2009 - 12.2012
Member Service Representative
Blue Cross Blue Shield
04.2007 - 07.2009
Some College (No Degree) - Medical Billing And Coding
Quincy College
Medical Administrative Assistant -
Lincoln Tech Allied Health
High School -
Revere High School