Executed in-depth analysis of patient records ensuring that all duplicates-new enrollments were properly processed and merged with master record and assigned to the correct territory and nurse ambassador team. Daily evaluating all patient identifying demographics including confirming the correct product drug assignment listed against enrollment forms and types to include patient diagnosis, and physician assignments. Manually creating PSOSC Click-Up tickets to be submitted for escalations when multiple duplicate patient records were identified or if additional updates were needed.Key Contributions:• Investigated, analyzed, and merging of over 200 to 300 potential duplicate patient records within automated Salesforce system utilizing MS Office skills (Word, Excel and Outlook).• Proficient in heavy data entry and meticulous with adherence to strict policy, procedure, and SOP’s guidelines.• Identified problems and sought resolution for patient pharmaceutical records, and escalation requests submitted by the nurse ambassador team.

Process wide-ranging requests for authorization, including inpatient admissions, outpatient procedures, skilled nursing visits, inpatient rehab, hospice, and scheduled surgeries. Engage with local, state, and federal government agencies on issues pertaining to company products and policies. Maintain meticulous records of details associated with calls and provide redirection if needed. Execute in-depth analysis on data and submit insight to team leads supporting employee development, or providers who require instruction on processes. Strive for first-contact resolution by communicating clearly with customers to identify issue, gather vital information, and provide counsel necessary to facilitate prompt mediation. Manage triage and assignment for all inbound inquiries, ensuring re-routing to appropriate team members.Key Contributions:• Recognized as one of the best intake specialists by producing 0 errors across 3 quarters. Earned department commendation for mastering expedited phone and faxed prior authorization, which enabled swifter decision-making and improved care access for members. Championed alignment with corporate mission and values through provision of world-class, enthusiastic service to all customers, which resulted in high levels of satisfaction and retention. Optimized quality of interactions by actively recognizing and anticipating customers’ needs.

Administered member verification, confirming medical and pharmaceutical coverage by contacting various insurance payors. Partnered with care coordinators and intake teams to obtain all required documents from patients, medical providers, and insurance payors. Supported seamless compliance with the company’s policies and guidelines.Key Contributions:• Handled high-priority cases, leveraging diplomacy and technical skill to ensure effective outcome. Secured new role after contract ended based on perfect attendance, flexibility, and team collaboration.

Verified patient insurance coverage and co-payments that were submitted by healthcare providers. Followed up to collect missing documentation needed for triaging cases. Confirmed patient insurance benefits with carriers and determined what co-payment amount the patient was responsible for. Executed a variety of administrative functions, including generating benefits summaries for healthcare facilities and securing approval for triage cases after processing.Key Contributions:• Regularly completed 10-12 cases per day, exceeding team’s daily goal of 7 cases per day. Consistently processed medical record requests and retrievals within strict turnaround time. Developed advanced understanding of Medicaid and commercial insurance policies used for confirming drugs that were dispensed, shipped, and reimbursed to healthcare facilities. Temporary leave of employment for medical reasons, resumed career in 2018.

Administered processing for all release of information requests, prioritizing expediency and accuracy. Delivered top-tier service and quality products to customers. Addressed incoming requests and inquiries by mail, phone, and in-person interactions with walk-ins. Followed required procedures and HIPAA guidelines when validating requests for release of medical information. Established high standards for quality and productivity among team members.Key Contributions:• Received increased salary and schedule flexibility after quickly mastering records request process. Safeguarded patients’ right to privacy by restricting access to medical information to only those who were authorized, and verifying information releases complied with company policies. Maximized accuracy, confidentiality, and correct invoicing by implementing quality checks.

Served as an onsite Medical Clerk at a busy hospital facility, St. Mary’s Hospital. Processed large volume of medical record requests and managed retrieval for external requests from patients, attorneys, and workers compensation cases.

Managed collection of patient health files in a neurosurgeon office for patients prior to scheduling inpatient and outpatient procedures. Filed records, assisted with audits, and collected information required for pre-operation scheduling.

Monitored physicians and healthcare facilities to evaluate compliance with industry regulations. Maintained records on insurance contracts and staff credentials. Ensured providers had completed appropriate training and licensing. Developed knowledge of medical staff bylaws, rules, and regulations. Prepared evaluations of practitioner credentials for review.