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Click here or scroll down to respond to this candidateJODIEREICHMyerstown, PA Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEPROFESSIONAL SUMMARYHighly trained LPN/Insurance Coordinator with 10+ years of expertise in securing prior authorizations and processing appeals/grievances for prescription medications including high priced specialty medications. Expertise with verifying insurance eligibility for Medicare/Medicaid and all health insurance plans along with authorization guidelines. Extensive Medicare/Medicaid and commercial health insurance knowledge. Excellent interpersonal skills with proven history of interpreting and explaining health insurance policy details to patients. Proficient in medical terminology and CPT, ICD-10 and HCPCS coding. Excellent documentation skills. Skilled in quickly resolving issues and liaising between insurance providers and policy holders.SKILLS Documentation Case management Critical thinking Task prioritization Time management Reliability Problem solving Insurance verification Medical billing and coding Insurance claims and denialprocesses ICD-10 coding Excellent administrative abilities Prior authorization processing Thorough knowledge of patient assistance programsEXPERIENCEClinical Review NurseCareCentrix Hartford, ConnecticutJuly 2022 - July 2023 Performed initial evaluation of sleep service referral for appropriateness. Reviewed information needed to make a medical necessity determination. Requested additional clinical information needed to make a determination. Used clinical expertise, reviewed clinical information and clinical criteria (CMS/MCG's) to determine if service request meets medical necessity criteria. Approved or elevated case to Medical Director for further review. Maintained working knowledge of insurance guidelines/policies. Triage LPN / Insurance CoordinatorWellspan Pulmonary and Sleep Medicine Ephrata, Pennsylvania July 2012 - February 2022 Maintained compliance with local, state and federal regulations governing insurance, Medicare and Medicaid requirements. Verified insurance and communicated coverage to staff and patients. Obtained prior authorization and precertification for outpatient procedures and high-cost biologic medications. Contacted insurance carriers to discuss policies and individual patient benefits. Prepared insurance claim forms or related documents and reviewed for completeness. Assured timely verification of insurance benefits prior to patient procedures or appointments. Maintained confidentiality of patient finances, records and health statuses. Licensed Practical NurseCentral Penn Nursing Care Inc. Lancaster, Pennsylvania June 2011 - July 2012 Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning. Collaborated with supervisor to assess patient needs, plan and modify care and implement interventions. Performed routine evaluations of each patient's status, needs and preferences. Home Care Licensed Practical NurseHospice of Lancaster County Lancaster, Pennsylvania May 2003 - December 2007 Identified and coordinated patient and family care to support patients and families in home or assisted living facility. Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions. Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms. Followed all personal and health data procedures to effectively comply with HIPPA laws and prevent information breaches. Communicated with healthcare team members to plan, implement and enhance treatment strategies. EDUCATIONDiploma LPN - Practical NursingLancaster County Career and Technology Center, Willow Street, Pennsylvania February 1997Professional license- LPN licensed in state of PA since September 1997 |
