A Customer & Tech Support Management, Patient Care Coordination, with technical and analytical skills, which are solution orientated. With vast experience in operation within the business process outsourcing sector, and the remote environment. As a Young Professional, I continue to thrive daily grasping every opportunity to hone and perfect my skills so that I may provide world-class service & solutions.
Experience
Circle Medical
Oct 2020 – Present
Remotely
Patient Care Coordinator
Responsible for obtaining prior authorizations for all medications by successfully completing the authorization process with all commercial payers.
• Completes and submits any forms and clinical documentation required to secure appropriate preauthorization(s) and insurance benefit(s) for scheduled services.
• Enters comments in the EHR system that are clear and concise so that the clinic(s) knows the coverage dates and any policy limits, deductibles, and co-pays, etc. that may need to be communicated with patients.
• Ensures authorization information is properly documented in EHR system which is necessary for accurate and timely claims submission to the respective insurance payers.
• Prepares Letter(s) of Medical Necessity and paperwork required for submitting appeals by insurance(s) to overturn denials for lack of authorization and /or lack of medical necessity, as needed.
• Prioritize incoming authorization requests according to the urgency
• Obtain authorization forms via payer website or by phone and follow up regularly on pending cases
• Respond to clinical questions regarding payer medical policy guidelines
• Confirm accuracy of ICD-10 diagnoses in the procedure order
• Interact with patients to discuss authorization status
• Interacts with patients when eligibility and benefits cannot be verified through the various payer portals, etc.
• Performs other duties as assigned.
* Resource Knowledge: Helpscout, DrChrono, Google Suite Products, EHR, Covermymeds EPA, Slack, EFax, Talkdesk, ESignature
