Patrick Walker Email & Phone Number

Brea, Ca.

•Manages the Utilization Management phone queues during business hours•Provides effective customer service to our clients by appropriately responding to emails, phone calls and/or any communication regarding requested information•Performs notification of medical necessity determinations in accordance with departmental policies, regulatory requirements, and client contractual agreements•Enters structured clinical data (including patient and provider demographics, HCPCS codes, JCODES, etc.) received via phone, fax, and/or online web portal into New Century Health’s online clinical system•Reviews authorization requests received via phone, fax, and/or online web portal for completeness of information •Accurately documents information received from members, physician’s offices, and health plan clients into New Century Health’s online clinical system•Processes authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements•At the direction of appropriate clinical staff, may contact the physician’s office or patient for additional information•Creates and generates reports using Microsoft Office, and/or New Century Health’s computer based programs•Performs clerical duties such as faxing and scanning documents, filing clinical into patients electronic chart, creating shipping labels, preparing letters and parcels using office machines, such as printers, photocopies, scanners, facisimilie machines, telephone and voice mail systems and computer based programs such as Microsoft Office

Brea, Ca.

•Manages the Utilization Management phone queues during business hours•Provides effective customer service to our clients by appropriately responding to emails, phone calls and/or any communication regarding requested information•Performs notification of medical necessity determinations in accordance with departmental policies, regulatory requirements, and client contractual agreements•Enters structured clinical data (including patient and provider demographics, HCPCS codes, JCODES, etc.) received via phone, fax, and/or online web portal into New Century Health’s online clinical system•Reviews authorization requests received via phone, fax, and/or online web portal for completeness of information •Accurately documents information received from members, physician’s offices, and health plan clients into New Century Health’s online clinical system•Processes authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreementsApprove chemotherapy treatment regimens based on pre-established criteria and guidelines.•Acquire structured clinical data under the direction of appropriate clinical staff and algorithms

Processed authorization requests from providers and clinical partners for In and Outpatient surgical and diagnostic procedures. Answered inquiries from providers, clinical partners, sales and other departments regarding prior authorizations and predetermination services and general processing of authorizations in Cigna's systems. Communicated both internally and externally to provide and verify information, explain processes and answer questions regarding eligibility and benefits.