Frances Marie Estrera
Medical Prior Authorization Coordinator, PH RMT
BUSAY, CEBU CITY,CEBU
Summary
Detail-oriented Medical Prior-Authorization Coordinator with 5+ years of experience in managing prior authorization requests, ensuring compliance with insurance policies, and facilitating seamless communication between healthcare providers and payers. Proficient in handling high-volume workflows and dedicated to optimizing patient care and reimbursement processes.
Overview
2
2
years of professional experience
1
1
Certification
Work History
Medical Prior Authorization Coordinator
Athenahealth
Cebu City, Province Of Cebu (Remote)
06.2023 - Current
- Contact all US payers to obtain prior authorization. Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization
- Conduct clinical discussions with insurance nurse reviewers for pended cases, providing necessary medical information and rationale for treatment plans / services to be rendered. Document communication with insurance companies and healthcare providers regarding authorization status.
- Ensure compliance with HIPAA regulations and other relevant healthcare standards in all documentation processes.
- Collaborate with healthcare providers, including physicians, nurses, and support staff, to facilitate prior authorization process. Effectively communicate with internal teams to coordinate patient care plans based on authorization status.
- Actively participate in team meetings to discuss authorization-related issues and strategies for improvement. Identify opportunities for process improvement and implement best practices to streamline authorization procedures.
- Adhere to all regulatory requirements and organizational policies related to prior authorization and insurance billing.
- Provide excellent customer service to patients, insurance representatives, and other stakeholders throughout authorization process.
- Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals
Laboratory Technician
PNP-Camp Crame General Hospital
Cebu City, Province Of Cebu
01.2023 - 06.2023
- Enhanced laboratory efficiency greatly by implementing new testing procedures and protocols.
- Assisted in the development of new laboratory methods, leading to increased testing capabilities.
- Entered quality test results, scanned paperwork into SAP and monitored SAP for completion of inspections.
Medical Technologist
Ultra Care Diagnostics
Cebu City, Province Of Cebu
09.2022 - 12.2022
- Enhanced patient care by accurately performing and interpreting laboratory tests in hematology, chemistry, microbiology, and blood bank departments.
- Upheld regulatory compliance by adhering to all relevant laws, guidelines, policies, and procedures related to medical laboratory practice.
- Enforced quality control protocols to maintain accuracy of test results.
- Maintained strict adherence to safety protocols, minimizing the risk of infection or contamination in the laboratory environment.
Education
Bachelor of Science - Medical Technology
Holy Name University
Tagbilaran, Philippines 04.2001 -
Skills
Customer Service
Problem-Solving
Prior Authorization Knowledge
HIPAA compliance awareness
Documentation And Reporting
Patient Confidentiality Adherence
Task Prioritization
Computer Proficiency
Problem-solving aptitude
Critical Thinking
Medical coding familiarity
Effective communication skills
Certification
PH Licensed Medical Technologist
Timeline
Medical Prior Authorization Coordinator
Athenahealth
06.2023 - Current
Laboratory Technician
PNP-Camp Crame General Hospital
01.2023 - 06.2023
Medical Technologist
Ultra Care Diagnostics
09.2022 - 12.2022
Bachelor of Science - Medical Technology
Holy Name University
04.2001 -