Abiud Mogoba

• Verified eligibility and compliance with authorization requirements for service providers.
• Fielded telephone inquiries on authorization details from plan members and medical staff.
• Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
• Tracked referral submission during facilitation of Claire authorization issuance.
• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
• Maintained compliance with patient privacy and security regulations.
• Authorized surgical requests in accordance with applicable plan guidelines.
• Collaborated with specialty offices to process patients lacking coverage for planned procedures.
• Escalated requests for non-standard services to insurances.
• Maintained patient confidentiality and safeguarded medical records to avoid information breaches.
• Contacted insurance companies to obtain Claire authorization for medical procedures and medications.
• Input all patient data regarding claims and Claire authorizations into system accurately.
• Reached out to insurance carriers to obtain Claire authorization for testing and procedures.
• Researched denied claims and contacted insurance companies to resolve these issues.
• Reviewed insurance coverage for patients to determine which party was liable for payment.

• Verified insurance benefits or eligibility and documented in eClinical Works and Soarian systems.
• Scanned prescriptions and reports.
• Communicated with outside facilities for scheduling tests or surgeries.
• Reviewed and maintained charts for completeness and compliance with EMR guidelines.
• Followed-up and documented patients' condition after surgery or other invasive procedures.
• Verified or obtained referral numbers or authorizations for upcoming appointments.
• Kept information confidential and followed HIPAA guidelines to maintain patient trust.
• Organized paperwork such as charts and reports for office and patient needs.
• Maintained current and accurate medical records for patients.
• Claireitized calls through screening process and transferred calls and recorded messages for appropriate personnel.
• Registered new patients in electronic medical records Claire to appointment scheduling.
• Maintained office supplies inventory by checking stock, anticipating department needs and placing and expediting orders.
• Supported office staff and operational requirements with administrative tasks.
• Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
• Enhanced office productivity by handling high volume of callers per day.
• Used knowledge of medical terminology to transcribe patient information from written copy, electronic equipment or verbal direction.
• Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing.
• Coordinated customer service, patient scheduling and billing.
• Located, checked in and pulled medical records for patient appointments and incomplete charts.
• Reviewed, screened and distributed daily mail correspondence to appropriate personnel.
• Proofread documents and correspondence for accuracy and completeness.
• Facilitated new patient prescriptions, refills, and prescription pre-authorizations.
• Kept office equipment operating by troubleshooting breakdowns, performing preventive maintenance and coordinating repairs.
• Entered orders and e-prescribe information and created clinical visit summaries.
• Completed and filed financial documentation for accounting purposes.

• Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
• Established workflow processes, monitored daily productivity and implemented modifications to improve overall performance of personnel.
• Coached new hires on company processes while managing employees to achieve maximum production.
• Evaluated employee records and productivity to complete employee evaluations.
• Developed standard operating procedures for all administrative employees.

LVN Supervisor

• Leading nurses on the shift to exercise Clinical Judgment and decision making about patient treatment.

• Training of new staff and continuing education of current staff.

• Participating in staff meetings, Team conferences, Environment of care meeting and contributing to discussions.

• Collaborated with interdisciplinary care team to develop care plans.

• Creating a safe environment for all patients, visitors and staff.

LVN staff nurse.

• Responsible for the G-tube and Coumadin medication and feeding, accu-checks and breathing treatments.

• Responsible for the NG tube insertion and maintenance and trach care.

• Responsible for Measuring, treatment and dressing wounds.

• Responsible for PICC line IV medication administration.

• Responsible for the direct patient care, medications, labs, admissions, discharge, plan of care, teaching and electronic documentation.

• Utilized client and staff feedback to maintain customer partnerships and increase revenue.
• Monitored and evaluated personnel performance to complete annual reviews, recommend advancement or address productivity concerns.

Duncanville Health Care Center. May 2012-July 2013

LVN staff nurse.

• Responsible for the G-tube and Coumadin medication and feeding, accu-checks and breathing treatments.

• Responsible for the NG tube insertion and maintenance and trach care.

• Responsible for Measuring, treatment and dressing wounds.

• Responsible for PICC line IV medication administration.

• Responsible for the direct patient care, medications, labs, admissions, discharge, plan of care, teaching and documentation.

Methodist Dallas Hospital. - Clinical Rotations

Preceptorship /VN program: 80 hour rotation – (Jun-July 2011)

Oncology unit /Med surg floor 140 hours rotation- (March –June)

Duties performed: patient head to toe assessments on newly admitted patients and on every new day on shift change, administration of medications (PO, IM, IVPB,G tube, subcutaneous) and various nursing skills including insertion of an indwelling catheter, wound dressing, maintenance of IV infusion, NG tube insertion . Under the supervision of the licensed nurse preceptor.

Nexion Health at Cross timbers Rehabilitation Center May 2008 - April 2012

Certified Nurse Assistant: 2007-2008

Responsibilities in this position included, ADLs, like feeding, toileting, showering, and also did the daily range of motions to a couple of clients who needed physical therapy.

Medication Aide: 2008-2012

Responsible for two halls of 30 to 40 residents a shift and in conjunction with the nurse we passed and administered medicine to the residents.

SKILLS:

• Excellent written and oral communication skills.

• Strong interpersonal, leadership, and teamwork skills.

• Ability to work in a flexible schedule.

High School- Suneka High school (Kenya) 1998-2001

High school Diploma.

MEMBERSHIPS/ACHIEVEMENTS:

Served as the Secretary of the Vocational Nursing Club, responsible for minutes taking, preparing the agendas and reading previous minutes.