Luis Enrique Zarate

As a proficient Health & Insurance associate, I have effectively documented CPT, HCPCS, ICD-10 codes, and medical terminology to submit referrals, prior authorizations and claims using EHR systems such as eClinicalWorks, eMedical, Availity, and Leading Reach, among others. My expertise lies in accurately gathering necessary patient information and meticulously reviewing appointment notes to ensure that each CPT and ICD-10 code is correctly assigned to the appropriate specialty and diagnosis.

I have experience in various healthcare payment models, including capitation, fee-for-service, bundled payments, episodes of care. I bring a comprehensive understanding of the financial mechanisms that drive healthcare reimbursement. My expertise ensures that healthcare providers receive accurate and timely payments.

I understand complex policies and coverage stages for each patient, with vast experience in how Medicare coverage works for all of its parts: A, B, C, and D, along with comprehensive training in coverage and policies, including deductibles, copays, co-insurances, True out-of-pocket costs, and tiers of coverage.

Additionally, I have a thorough understanding of how each policy functions within different plans, whether they are PPOs, HMOs, EPOs, or POS plans. This proficiency allows me to navigate the nuances of each plan effectively, ensuring optimal reimbursement and coverage for healthcare services.

In my role as a Health & Insurance associate, I have gained extensive experience documenting CPT, HCPCS, and ICD-10 codes, and medical terminology to submit claims, referrals and prior authorizations. I excel at accurately gathering patient information and meticulously reviewing appointment notes to ensure that each CPT and ICD-10 code is correctly assigned to the appropriate specialty and diagnosis.

I have worked with various healthcare payment models, including capitation, fee-for-service, bundled payments, and episodes of care. This has provided me with a comprehensive understanding of the financial mechanisms that drive healthcare reimbursement, ensuring that healthcare providers receive accurate and timely payments.

Some of my duties were:

- Documented CPT, HCPCS, ICD-10 codes, and medical terminology to submit referrals and claims using EHR systems such as eClinicalWorks, eMedical, Availity, and Leading Reach, among others.
- Gathered necessary patient information and reviewed appointment notes to ensure each ICD-10 code was correctly assigned to the appropriate specialty and diagnosis, facilitating the selection of the right doctor for the right procedure.
- Assisted in managing patient medical records, capturing, and updating relevant information related to the patient's history of present illness (HPI), including documenting patient symptoms, medical history, and other pertinent details accurately and confidentially in the electronic health records (EHR).
- Maintained communication with other doctor's offices or healthcare facilities to coordinate patient care, which included making inquiries, exchanging medical records or information, and facilitating consultations between healthcare providers.
- Managed a high volume of calls, handling and resolving inquiries and issues with exceptional communication and problem-solving skills (inbound and outbound).
- Submitted prior authorizations, coverage determination requests, tier exceptions, and reimbursements by documenting information and faxing or emailing it to the corresponding department.

- Monitored the status of submitted claims, followed up on denials or rejections, and resolved any issues that arose during the claims processing cycle. This included appealing denied claims and resubmitting corrected claims as needed.

Bachelor’s degree in Industrial Engineering