
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.
• 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.
Created and implemented secure filing systems for sensitive employee documents.