
Knowledgeable with solid educational background in legal support and document management. Professional and dedicated employee skilled in facilitating conference calls. Previously, as a Specialist, I executed non-clinical aspects of Case Management, overseeing 100+ members weekly and maintaining meticulous documentation. My experience in healthcare has taught me to maintain confidentiality and understand the importance of HIPAA laws. My experience as a Correctional Officer honed my ability to enforce rules, ensure safety, and maintain facility standards. Equipped with a Bachelor's degree in Criminal Justice and an Associate's degree, I bring extensive knowledge in elements of the justice system, understanding of legal terminology and documentation along with strong multitasking, adaptability, and effective time management abilities to drive success in any role.
Observed and supervised inmates throughout visits, meal time, recreation, phone calls, and showers.
Conducted routine and emergency head counts.
Enhanced facility security by conducting regular inspections and addressing potential risks.
Demonstrated cultural sensitivity when interacting with diverse populations within the correctional setting, promoting an inclusive environment for all individuals present.
Lead the patient insurance authorization process for services that are requested by the clinical staff responsible for the patient's care Work proactively with insurance carriers to ensure that all of the required information has been received in a timely fashion. Communicate and advise the clinical team on any changes in insurance companies reimbursement practices related to the authorization of process. Facilitate conference calls with clinical team and patient insurance when needed. Escalate the need for patient reeducation and counseling on their insurance coverage and explain payment options that available to them.
Responsible for execution of non-clinical aspects of Case Management process. Ensure information is appropriately entered in system to effectively execute member care plans, originate authorizations, request clinical information, and perform case research.Outreach at least 100 members weekly.Facilitate all clerical and administrative processes and activities. Triage cases and assign receipts to appropriate teams. Perform other related projects and duties as assigned. Respond to inquiries from providers, facilities and members Enter and maintain documentation in medical management workflow tool meeting defined time frames and performance standards. Actively participate in assigned committees and projects