Amy Watson
Greenville,NY
Summary
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
21
21
years of professional experience
Work History
Senior Clinical Coordinator
HCAP - NYS Empire Plan
03.2024 - Current
- Distribute work to team
- Coordinate predetermination with Anthem (Memo 40)
- Approving cases
- Handling all incoming site of care cases
- Create site of care cases
- Appeals
- Handle incoming faxes
- Manage team chat/mentor
- Mentored new clinical staff members for proper onboarding and orientation processes.
- Enhanced interdisciplinary collaboration through effective communication and coordination among healthcare team members.
- Coordinated, monitored, assigned, and documented
- Implemented new policies and educated staff on changes.
Clinical Coordinator
HCAP - NYS Empire Plan
05.2022 - 03.2024
- Manage administrative intake for members and providers
- Collaborate with healthcare facilities and clinical teams to fulfill service requests
- Process prior authorizations, including intake and notification
- Aid clinical staff in document setup and case triage for Clinical Coverage Review
- Resolve inquiries from members and providers
- Aid in staff training
- Assist with Empire Directory
- Proficient in ICD-10 diagnosis codes and CPT/HCPCS codes
- Serve as backup for different queues and Peer to Peer with Medical Director
- Recognized as United Health Care Service Hero
Customer Service Representative(Optum Behaveral)
Optum
12.2020 - 05.2022
- Leader considered me a Subject Matter Expert
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
- Handled 5 to 10 escalated emails efficiently, finding satisfactory resolutions for both customers and the company alike.
Manager
New Baltimore Family Dentistry
09.2012 - 12.2020
- Managed 25 high volume of internal and external communications
- Credentialed providers with all dental insurance companies
- Processed claims & adjustments
- Sent prior authorization to dental insurance companies for dental treatment
- Supervised and trained staff
- HIPAA and OSHA training
Claims Examiner/Customer Service
Davis Vision
07.2004 - 08.2012
- Researched and resolved vision claims approximately 75 to 100
- Audited processed claims for quality assurance
- Conducted claims training sessions
- Responded to inquiries on claim benefits, enrollment, and business matters
- Built customer relationships through phone, written correspondence, and walk-ins
- Provided prompt and accurate information to members and providers on policies, benefits, and procedures
Education
GED -
Ravena Coeymans Selkirk
Selkirk NY06.1998
Skills
- Management
- Claims Processing and Adjustments
- Team Training & Development
- UNET/ICUE and ISET
- Strong Communication & Presentation Skills
- Medical Coding
- Calendar and Teams Management
- Clinical documentation
- Developing training programs
- Medical records management
- Medical database expertise
- HIPAA compliance
- Metrics tracking
- Critical thinking
- Data analysis
Timeline
Senior Clinical Coordinator
HCAP - NYS Empire Plan
03.2024 - Current
Clinical Coordinator
HCAP - NYS Empire Plan
05.2022 - 03.2024
Customer Service Representative(Optum Behaveral)
Optum
12.2020 - 05.2022
Manager
New Baltimore Family Dentistry
09.2012 - 12.2020
Claims Examiner/Customer Service
Davis Vision
07.2004 - 08.2012
GED -
Ravena Coeymans Selkirk
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