Nancy Barraza

Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim. Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line. Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner. Conducts in-depth pre-existing condition or contestable investigations if applicable.

Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc. Develops and maintains on-line claim data (and paper file if applicable). Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. Analysis and Adjudication of benefits. Ongoing Case Management.

Manage leave requests ensuring compliance with regulations, enhancing process efficiency. Oversee leave of absence requests, including continuous FMLA, short-term disability, long-term disability, and other applicable leave programs, voluntary. Ensure compliance with all relevant federal, state, and local regulations.

Serve as main contact for leave inquiries, providing clear policy information. Coordinate with HR and payroll for seamless employee transition during leave. Maintain communication with employees on leave, facilitating smooth return. Identify process improvements in leave administration, recommending effective solutions.

Assist physicians with exams and procedures as requested; administer subcutaneous and intramuscular injections, as delegated by RN or physician. Escort patients to and from exam rooms, physician offices, and treatment room as appropriate. Obtain all necessary patient records and vitals as required by physician prior to treatment or procedures. Perform other administrative duties, i.e. data entry, filing, faxing, chart preparation, reception, etc., as requested by supervisor or physician. Phone in prescriptions and make other patient calls as directed by physicians and RN’s, triage patient phone calls. Authorization for non-covered prescriptions. Scheduling and Authorizations for out of office procedures such and blood transfusions. Prepare and stock exam/treatment rooms and order supplies as needed; maintain all exam/treatment room disinfection protocols.

Coordinates surgical assists, proper equipment, ensures proper anesthesia for all surgeries and procedures. Assist in timely scheduling, arranging, and answering all patient and provider questions regarding surgical appointments, including pre-operative/post-operative appointments, outside medical labs, diagnostic test, medical clearances, etc. Coordinate with hospitals, surgery centers, insurance companies, and all other patient related facilities as required by the assigned provider

Obtains proper authorization for surgical procedures, which includes extensive knowledge of ICD-10 and CPT coding as needed. Submits all hospital charges to the business office in a timely manner, including obtaining medical records from outside facilities and creating patient accounts as required to complete the task. Following all data entry protocols such as, researching accounts, entering/updating demographics, obtaining correct insurance information. Accurately establishes and maintains physicians’ outside clinics and in-patients at all hospital facilities.

Consistently maintains EMR work lists, task lists, and related call processing messages. Maintains and updates all information on physician’s calendars (including physician time off), daily schedules, system templates and communicating this information to the appropriate staff. Assists with preparations of agendas, materials, meetings, etc as requested by the provider

Translates for physicians if bilingual.

Coordinates surgical assists, ensures the availability of appropriate equipment, and verifies proper anesthesia arrangements for all surgeries and procedures. Manages the timely scheduling of surgical appointments, including pre-operative and post-operative visits, diagnostic tests, medical clearances, and outside medical labs. Responds promptly to all patient and provider inquiries related to surgical scheduling. Collaborates with hospitals, surgery centers, insurance companies, and other patient-related facilities to facilitate seamless care, as required by the assigned provider. Secures prior authorizations for surgical procedures, requiring extensive knowledge of ICD-10 and CPT coding. Submits hospital charges to the business office in a timely manner. This includes obtaining medical records from outside facilities and creating patient accounts when necessary. Follows all data entry protocols: researches patient accounts, updates demographic details, and ensures accurate insurance information is on file. Establishes and maintains physician schedules at outside clinics and inpatient hospital facilities with accuracy and consistency. Maintains EMR worklists, task lists, and manages incoming messages and calls related to surgical coordination. Updates and manages physician calendars, including vacation/time-off schedules, daily templates, and clinical activities, and communicates these updates to relevant staff. Assists with preparation of meeting materials, agendas, and other administrative support tasks as requested by the provider. Provides interpretation and translation services for physicians, if bilingual.

Led clinical team, enhancing patient care quality and operational efficiency. Mentored staff, fostering professional growth and a collaborative environment. Streamlined processes, achieving measurable improvements in care delivery. Ensured compliance with regulations, maintaining high standards of care. Facilitated communication, strengthening team and stakeholder collaboration.

Led back office team, enhancing workflow and reducing patient wait times. Trained and supervised staff, improving performance and development. Managed EMR systems, ensuring compliance and smooth operations. Coordinated patient care, optimizing scheduling and follow-up processes. Conducted audits and maintained inventory, supporting clinic efficiency.

Assist with front or back office as needed. Greeted and checked in patients; managed multi-line phones and responded to inquiries. Scheduled and confirmed appointments; maintained appointment calendar. Collected co-pays, verified insurance, and updated patient records. Facilitated internal office communication and specialist referrals. Assisted with billing, claims processing, and patient payment collections. Supported clinical procedures, took vital signs, and prepared patients for exams. Maintained accurate and confidential patient medical records. Managed medical supplies, stocked inventory, and sanitized exam rooms. Handled data entry, record management, and report generation. Verified insurance eligibility and supported claims and billing processes.