Rina Perez
Chicago
Summary
Dependable Prior Authorization Specialist with a career spent handling various administrative responsibilities in fast-paced settings. Bilingual individual dedicated to finding solutions to issues and obtaining prior authorization information for patients. Ready to tackle new challenges in an office-based environment.
Overview
21
21
years of professional experience
Work History
Prior Authorization Specialist
ADDISON GROUP
Chicago
04.2025 - Current
- Submitting authorization requests to insurance companies for approval of services (e.g., ABA therapy, speech therapy) on a timely basis
- Understanding and managing prior authorization & authorization requirements
- Renewing authorizations before they expire to prevent service interruptions
- Following up on pending authorizations to ensure timely approvals
- Communicating with providers regarding authorization requirements, status and restrictions
- Maintaining an organized system to track records of approvals, denials, and communications with insurance & providers
- Ensuring that approved authorizations are properly documented for billing purposes
- Audit and submit billing for Speech services
- Following up with payers regarding provider credentialing status
- Maintain provider verification with various systems to continue in compliance
- Update credentialing tracking sheets and providers files
- Assisting with audits and accreditation reviews.
Referrals/Authorization Specialist
OAK STREET HEALTH CLINIC
Oakbrook Terrace
01.2019 - 11.2024
- Responsible for managing the day-to-day referrals for specialists, patients and facilities.
- Interacting with clinic teams and PCP partners to ensure patients have access to the care they need in a timely manner
- Scheduling appointments within the electronic medical records system
- Communicating authorization to 3rd parties upon request
- Requesting medical records, submitting appropriate clinical documents to specialist offices
- Gathering information concerning patients clinical background and referrals
- Scheduling specialist appointments and/or diagnostic orders as needed
Hospital Unit Coordinator
WESTLAKE HOSPITAL
Melrose Park
09.2018 - 01.2019
- Received and made outgoing calls.
- Processed the ER charts for incoming and outgoing patients.
- Assisted the ER physician, ordering labs, and orders
Medical Billing Specialist
HOLY CROSS HOSPITAL (ER)
Chicago
07.2006 - 07.2018
- Compiled and copied patient charts for review of quality control initiatives by ER management
- Monitored and tracked all Emergency department patient charts and triage patients
- Responded to patient billing inquires
- Entered ICD-9 and CPT codes for the ER
- Filed and organized patient charts
- Verified patient insurance information
- Trained new employees
Health Unit Coordinator
HOLY CROSS HOSPITAL (ER)
Chicago
11.2004 - 07.2006
- Adhered to all organizational policies and procedures regarding safety, infection control and patient confidentiality
- Communicated with other hospitals to facilitate transfers and specialty care
- Answered high volume calls in a fast-paced environment
Education
Skills
- ICD-9 coding
- ICD-10 coding
- HMO's
- PPO's
- Medicare
- Quality assurance
- Auditing
- Medical billing
- Medical records management
- Patient confidentiality
- CPT coding
- HCPCS coding
- Microsoft Access
- Microsoft Word
- Microsoft Excel
- Hospitality
- Leadership
- Teamwork
- Productivity
- Adaptability
- Rapport building
- Organizational skills
- Multi-tasking
- Communication
- Collaboration
Timeline
Prior Authorization Specialist
ADDISON GROUP
04.2025 - Current
Referrals/Authorization Specialist
OAK STREET HEALTH CLINIC
01.2019 - 11.2024
Hospital Unit Coordinator
WESTLAKE HOSPITAL
09.2018 - 01.2019
Medical Billing Specialist
HOLY CROSS HOSPITAL (ER)
07.2006 - 07.2018
Health Unit Coordinator
HOLY CROSS HOSPITAL (ER)
11.2004 - 07.2006
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