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Click here or scroll down to respond to this candidateCandidate's Name
Hoffman Estates, IL Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLEProfessional SummaryDetail-oriented team player with strong organizational skills and cross-functional in all health related areas such as Trauma, Prior Authorization and Case Management. Ability to handle multiple projects simultaneously with a high degree of accuracy.Skills ICD-9 and ICD-10 Coding Epic Trauma informed care Cognitive Behavioral Therapy Community Presentations Crisis Management Individual services Group services Children and Families Suicide Risk Assessment Psychological Assessment Problem-Solving Teamwork and Collaboration Time Management Problem-solving abilities Excellent Communication Patient Education Analytical Thinking Task Prioritization Various Electronic Medical Record SoftwareWork HistoryEligibility and Prior Authorization Specialist, 05/2024 to 08/2025 Natera Los Angeles, United States Expedited treatment commencement by promptly acquiring authorizations for medically necessary services within required timeframes. Assisted clients with accurate eligibility form, application and document completion. Enhanced interdepartmental collaboration through effective communication with case managers, physicians, and billing departments. Analyzed trends in denials or authorization delays to identify opportunities for improvement within the precertification department. Maintained strict adherence to HIPAA regulations by safeguarding confidential patient information during all aspects of the precertification process. Scheduled appointments with applicants to gather information and explain benefits processes. Trained staff on current eligibility requirements and policies. Assisted with medical coding and billing tasks. Received and routed laboratory results to correct clinical staff members. Lead Prior Authorization Specialist/Financial Navigator, 09/2021 to 05/2024 Kindbody Chicago, United States Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies. Assisted in the development of departmental guidelines and procedures for prior authorization processes, improving overall efficiency. Tracked referral submission during facilitation of prior authorization issuance. Researched denied claims and contacted insurance companies to resolve these issues. Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations. Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures. Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes. Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations. Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures. Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria. Participated in cross-functional initiatives to improve overall efficiency and effectiveness of the prior authorization process for all involved parties.Trauma Care Coordinator, 03/2012 to 06/2018Northwestern Medicine Chicago, United States Provided crisis and short term therapy to survivors of sexual violence and those who support them. Individual and group services provided beginning 3 years of age. Presented information to community agencies to increase the understanding of trauma informed care and services. Served as a liaison between hospital administration and clinical staff to address ongoing needs within the trauma program. Collaborated with local emergency medical services to improve pre-hospital care for trauma patients. Assisted in maintaining certification standards set forth by regulatory agencies, ensuring compliance with all requirements. Coordinated multidisciplinary team efforts to ensure efficient patient care during trauma situations. Provided education and training opportunities to hospital staff on current trends in trauma management, fostering a culture of continuous learning. Implemented injury prevention programs within the community to reduce instances of traumatic injuries requiring hospitalization. Built strong relationships with patients and families for optimized care satisfaction. Led physicians, nurses and healthcare teams in providing punctual, professional care delivery. Communicated with patients, ensuring that medical information was kept private. EducationBachelor of Science: Health Administration, 05/2015 National Louis University - Chicago, IL 4.0 GPA Academic Distinction MemberCertified Nursing Assistant: Nursing, 10/2010Malcolm X College - Chicago, United States |
