Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

Madeline Mansker

Carbondale

Summary

Experienced healthcare professional with strong background in utilization review and care coordination. Proven ability to assess medical necessity, optimize resource use, and ensure compliance with healthcare regulations. Focused on team collaboration and achieving results, adapting to changing needs efficiently. Highly skilled in clinical guideline adherence, patient advocacy, and effective communication.

Proficient Office Coordinator successful at efficiently and accurately managing records and databases. Performance-oriented and driven with in-depth understanding of budgets, payroll and office organization needs. Skillfully coordinate resources and administrative support to keep operations smooth and boost team productivity.

Articulate communicator with natural leadership skills and team building expertise demonstrated through 14 years of experience in office environments. History of improving processes and increasing team efficiency.

Overview

17
17
years of professional experience

Work History

Utilization Review Coordinator

Molina Healthcare
Remote
09.2023 - Current

• Provides telephone, clerical and data entry support for the care review team.
• Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges and billing codes.
• Responds to requests for authorization of services submitted via phone, fax and mail according to operational timeframes.

  • Coordinated peer review sessions among medical directors to assess and address case denial decisions.
  • Evaluated medical necessity for services based on established clinical guidelines.

Office Coordinator

Southern Illinois Healthcare
Carbondale, IL
11.2021 - 09.2023

Created and implemented secure filing systems for sensitive employee documents.

  • Increased team productivity by reorganizing office supplies and protocols.
  • Reconciled account files and produced monthly reports.
  • Routed correspondence to facilitate timely communication between team members, management and vendors.
  • Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
  • Supported HR by completing new hire orientation, incident reports and benefits paperwork on behalf of office employees.
  • Responsible for placing merchandise orders with Silkworm, Henry printing and Peacock printing
  • Assisted with implementing record storage initiative
  • Pioneered changes with senior leadership growing new culture, making new processes and improving on old processes in Warehouse transition.
  • Recording detailed minutes for VAT meetings
  • Scheduling interviews for hiring manager for all warehouse staff
  • Consolidate and reconcile accounting expenses for warehouse staff
  • Developed and maintained office procedures to ensure compliance with organizational standards.

Patient Intake Representative/Pre Certification Authorization

Southern Illinois Healthcare
Carbondale , IL
12.2019 - 11.2021
  • Register patients within hospital for all procedures including Inpatient and Outpatient
  • Transcribe all orders for outpatient services
  • Look up orders in epic and verify correct destination and service for patients
  • Handle incoming calls
  • Transport patients as needed
  • Call patients insurance company for authorization on prior and current hospital admissions
  • Maintain workque volumes for discharged patients, MSPQ, and missing information
  • Manage incoming faxes, upload orders from doctor's office into correct folder
  • Knowledgeable about insurance verification and fixing errors.

Office Manager

Farmers Insurance Group
Arnold, MO
12.2018 - 10.2019
  • Overseeing front of office duties
  • Build and maintain positive rapport with current and prospective customers
  • Respond to all inquiries regarding policy change and added vehicles or services offered
  • Resolve and complaints and answer prospect inquires in timely professional manner
  • Quote/bind and onboard all new business personal line polices
  • Use cross sell and upsell marketing list to contact new Customers about new products and importance of being properly insured
  • Handled all claims in sensitive proficient manner, making claims process swift and easy
  • Sympathizing and listening to customers in catastrophic situations and finding solution to ease loss
  • Communicated with clients
  • Supported and trained staff
  • Maintained and supervised office operations
  • Processed collections, deposits and billing on daily basis.

Operations Analyst

Verizon
Anchorage, AK
10.2015 - 04.2017
  • Organized /conducted weekly staff meeting, discussed new projects, objectives, and career development strategies
  • Reviewed, reconciled, and annotated documents, such as work orders, bills of sale and shipping orders to accommodate seamless transition of materials
  • Merchandise and fixed store front while maintaining back of store for employees
  • Filing and keeping accurate records on all paperwork
  • Placing work orders for facility to keep stores appearance above standard.

Sales Representative

Verizon
Anchorage, AK
11.2010 - 04.2015
  • Sell merchandise, such as phones, accessories, plans and solution for customer
  • Drive revenue and increase gross gains
  • Customizing right solution for customer while maximizing all potential leads and revenue
  • Achieved daily sales goal by cross selling and promoting additional products and services
  • Ability to work as part of team and take initiative independent of direct supervision
  • Built rapport with customers by asking probing questions and utilizing effective listening skills.

Customer Service Representative

Verizon
Carbondale , IL
11.2009 - 08.2010
  • Recommend potential products or services, analyzing needs, and providing customized solution for customer
  • Handle complaints, provide appropriate recommendations, and follow up with satisfactory solution
  • Assist with placement of orders, refunds, or exchanges
  • Assisted with technical support duties

Pharmacy Technician

CVS
Marion , IL
10.2008 - 10.2009
  • Maintain pharmacy inventory by checking pharmaceutical stock to determine inventory level, anticipating needed medications and supplies, placing and expediting orders; verifying receipt, removing outdated drugs
  • Organize medications for pharmacist to dispense by reading medication orders and prescriptions, preparing labels, calculating quantities
  • Answer incoming phone calls and field patient questions
  • Contact doctor's offices or hospitals to clarify prescription information.

Education

High school diploma -

Carbondale Comm High School
Carbondale, IL
05-2003

Skills

  • UMK2 proficiency
  • QNXT proficiency
  • Teamwork and collaboration
  • Friendly, positive attitude
  • Pega proficiency
  • Windows, SAP, Microsoft Office (10 years), Customer Service, Sales, Salesforce, Marketing,
  • Quickbooks, Communications, retail sales, Excel, Microsoft Office, Microsoft Word
  • Office Management
  • Cold Calling
  • Training & Development
  • Pharmacy Technician Experience
  • Insurance Sales
  • Technical Support
  • Account Management
  • Epic proficiency
  • Insurance Verification
  • Medical Records
  • Sales Management
  • Payroll
  • Underwriting
  • Employee Orientation
  • Medical Office Experience
  • Transcription
  • Medical Terminology
  • Management
  • Certifications and Licenses
  • Property and Casualty License
  • Business Administration
  • Account Reconciliation
  • Vendor Relations
  • Records Management
  • Office Supplies and Inventory
  • Mail Handling
  • Project Management
  • Employee Timesheet Processing
  • Inventory Auditing
  • Travel Coordination
  • Healthcare regulations
  • HIPAA compliance

Additional Information

  • Willing to relocate: Anywhere

Timeline

Utilization Review Coordinator

Molina Healthcare
09.2023 - Current

Office Coordinator

Southern Illinois Healthcare
11.2021 - 09.2023

Patient Intake Representative/Pre Certification Authorization

Southern Illinois Healthcare
12.2019 - 11.2021

Office Manager

Farmers Insurance Group
12.2018 - 10.2019

Operations Analyst

Verizon
10.2015 - 04.2017

Sales Representative

Verizon
11.2010 - 04.2015

Customer Service Representative

Verizon
11.2009 - 08.2010

Pharmacy Technician

CVS
10.2008 - 10.2009

High school diploma -

Carbondale Comm High School
Madeline Mansker