Deverly Catilosa

• Processed patient authorizations efficiently to ensure timely service delivery.
• Coordinated with healthcare providers to verify insurance coverage and eligibility.
• Reviewed documentation for accuracy, ensuring compliance with regulatory standards.
• Trained new staff on authorization procedures and system usage best practices.
• Collaborated with cross-functional teams to streamline authorization workflows.
• Implemented quality control measures that increased authorization approval rates significantly.
• Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
• Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
• Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
• Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
• Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
• Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
• Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
• Developed strong relationships with insurance representatives to expedite approvals and resolve issues promptly.

• Developed and maintained comprehensive documentation for medical equipment processes and compliance standards.
• Streamlined documentation workflows to enhance efficiency and accuracy across departments.
• Collaborated with cross-functional teams to ensure alignment on documentation practices and regulatory requirements.
• Trained new staff on documentation protocols, improving onboarding experience and knowledge retention.
• Ensured compliance with regulatory requirements by diligently updating documentation according to changing guidelines.

• Developed and implemented HIPAA compliance training programs for staff across multiple departments.
• Conducted regular audits to ensure adherence to HIPAA regulations and identify areas for improvement.
• Collaborated with legal team to interpret regulatory changes affecting organizational policies and procedures.
• Established monitoring systems to track compliance metrics and report findings to senior management.

• Developed strong relationships with healthcare providers to ensure efficient equipment delivery and support.
• Educated patients on proper usage and maintenance of durable medical equipment for optimal care outcomes.
• Coordinated with insurance companies for timely authorization and reimbursement processes.
• Conducted thorough assessments to determine patient needs and recommend appropriate equipment solutions.
• DME Product Request Management Process requests for a wide range of DME products including wheelchairs, hospital beds, walkers, feeding pumps, CPAP machines, oxygen systems, and other essential equipment.
• High-Value Equipment Oversight Prioritize and manage requests for high-dollar items such as ventilators, ensuring accuracy, compliance, and timely fulfillment.
• Documentation & Compliance Review physician prescriptions, prior authorizations, and insurance requirements to meet CMS and payer standards.

Verify Pick-Up Request

• Confirm patient or facility details
• Validate insurance or provider authorization
• Check equipment type and serial numbers

Schedule Pick-Up

Use DME Management Software → Scheduling Module

• Contact patient or facility to agree on time
• Assign staff or courier
• Document schedule in system

• Code Verification Review and validate ICD-10 diagnosis codes submitted with DME requests to ensure medical necessity and payer compliance.
• Documentation Alignment Cross-check physician orders, clinical notes, and supporting documentation against qualifying codes required for durable medical equipment approval.
• Insurance Compliance Ensure diagnosis codes meet CMS and private payer guidelines, reducing claim denials and delays.