Juliana

Experiencia demostrada en Referral Management.

Experiencia demostrada en Prior Authorization Processing.

Experiencia demostrada en Radiology Coordination.

Experiencia demostrada en Medical Terminology.

Experiencia demostrada en EHR Documentation.

Managed referral and diagnostic authorization workflows for a U.S. primary care practice, ensuring timely coordination between patients, providers, specialists, diagnostic facilities, and insurance carriers.. Processed and tracked clinic referrals to specialty providers, ensuring accuracy and timely follow-up.. Coordinated radilogy prior authorizations, including submission, follow-up, approval tracking, and delivery of authorizations to radiology facilities.. Reviewed referrals and supporting documentation to ensure patients were assigned to the appropriate specialist and authorization requirements were met.. Served as the primary point of contact for patients, providers, specialists, diagnostic centers, and insurance companies regarding referral and authorization status.. Maintained detailed documentation and communication logs in eClinicalWorks (eCW) to ensure continuity of care and accurate case tracking.. Managed high-volume referral and authorization requests while maintaining accuracy.. Followed up on pending referrals and authorizations to prevent delays in patient care and specialty services.. Collaborated with clinical and administrative teams to ensure efficient coordination of patient care.

Coordinated radiology authorizations and patient scheduling for a multi-specialty healthcare organization, ensuring timely approvals, accurate documentation, and effective communication among patients, providers, imaging facilities, and insurance carriers.. Processed prior authorization requests for diagnostic imaging services in accordance with payer requirements and clinical guidelines.. Reviewed medical records, provider documentation, clinical notes, and diagnosis/procedure codes to support authorization submissions.. Verified insurance eligibility and authorization requirements prior to submitting requests.. Coordinated scheduling with radiology facilities and communicated appointment details and preparation instructions to patients.. Monitored authorization status and followed up with insurance carriers to obtain timely determinations and prevent delays in care.. Served as a liaison between patients, providers, imaging centers, and insurance representatives throughout the authorization process.. Maintained accurate documentation and case updates within the EHR to support continuity of care and efficient case management.. Managed multiple authorization requests simultaneously while maintaining accuracy, organization, and compliance with payer requirements.

Supported a U.S. pain management practice by coordinating prior authorization requests, managing supporting documentation, and ensuring compliance with payer requirements to facilitate timely treatment approvals.. Processed and tracked prior authorization requests for pain management procedures in accordance with payer guidelines and clinical requirements.. Reviewed authorization requirements and coordinated supporting documentation, including medical records, imaging reports, and clinical notes.. Collaborated with providers to obtain additional information needed to support authorization requests and prevent delays in patient care.. Communicated with insurance carriers regarding authorization status, coverage requirements, and determination updates.. Provided guidance to providers on payer requirements, authorization criteria, and plan limitations to improve approval efficiency.. Maintained accurate documentation and authorization records to support case tracking and continuity of care.. Followed up on pending authorizations and resolved issues related to missing documentation or insurance requirements.. Coordinated communication between providers, patients, and insurance representatives to ensure an efficient authorization process.