Briana Cano

• Lead transportation specialist responsible for coordinating and managing transportation-related authorizations and documentation to ensure efficient and compliant operations.
• Verified eligibility and compliance with authorization requirements for service providers.
• Tracked referral submission during facilitation of prior authorization issuance
• Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
• Reduced turnaround time for prior authorization approvals with thorough documentation and timely follow-ups with insurance providers.
• Managed a high volume of prior authorization requests, consistently meeting deadlines while maintaining attention to detail.
• Evaluated clinical criteria for approval or denial of services requiring pre-authorization.

• Lead activities for daily discharge coordination for Medicare Advantage members
• Monitor Medicare Advantage members every day they are admitted to an IP facility for any discharge needs
• Contact point person to call the hospital contact person to get any member clinical notes or help to facilitate discharge coordination, check on auth status
• Schedule follow up appointments with PCP, follow up for DME equipment that MD ordered, follow up with Home Health for start of care date
• Collaborate cross functionally with the Prior Auth and Concurrent Review Nurse team for member discharge planning.

• Prepared offs for review, identifying in network and contracted providers.
• Collected clinical information required to pre-authorize services assess medical necessity, out of network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, and plan benefits.
• Responsible for communicating authorization status to providers and members in a timely manner as indicated by health plan.
• Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.

• Maintains company efficiency by working with team members and patients to provide a better and healthy life style for those in need

Monitor and coordinate patients' treatment plans, educate them about their condition, connect them with health care providers, and evaluate their progress.

• Identify and assess customers’ needs to achieve their goals and my company’s
• Build sustainable relationships and trust with customer accounts through active and cooperative communication
• Keep records of customer interactions, process customer accounts and file documents to ensure cross company communication
• Follow communication procedures, guidelines and policies