Summary
Overview
Work History
Education
Skills
Timeline
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Bridgette Fernandez

Tallahassee,FL

Summary

Compassionate Case Manager experienced in fast-paced environments. Hardworking and dedicated to achieving desired case outcomes. Offers excellent problem-solving, conflict resolution and communication abilities.

Overview

5
5
years of professional experience

Work History

Case Manager

Cardinal Health
11.2023 - Current
  • Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals, etc. All avenues to obtain coverage for the product must be fully exhausted
  • Creates and completes accurate applications for enrollment with a sense of urgency
  • Exceeds key performance indicators including service levels, call volumes, adherence, and quality standards.
  • Daily Average Adherence: >90%
  • Monthly Average QA Score: 96%
  • Follows up with patients, pharmacies, physicians, and other support organizations as needed regarding inquiries.
  • Handles sensitive information and personal data with discretion including prescriptions, personal information, date of birth, financials, and insurance information.
  • Maintain quality while providing an empathetic and supportive experience to the patients, doctors, and physician offices.
  • Influential genuine leader; sought out by others for help. Holds self to high standards while motivating and inspiring others to be their best.
  • Utilized by Leadership as a mentor for new agents, embracing the opportunity to develop my own leadership aspirations in the process.
  • Ability to adapt to changes fluidly. Applies recommendations to immediate practice, reinforcing a proactive approach to change and adjustments.
  • Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.

Insurance Claims Specialist

Orlando Health
11.2021 - 08.2023
  • Examined policy coverage forms and other records to determine insurance coverage
  • Adhered to claims processing policies and procedures, grievance procedures, state mandates and benefit plan documents to address claims
  • Resolved inaccurate payments with insurance carriers that are not in compliance with payer contracts or governmental agency rates on individual accounts
  • Research, initiate follow-up, and resolve health care insurance claim accounts
  • Utilized correct coding for insurance policies and state law requirements.
  • Strengthened client relationships by providing clear communication throughout the claims process, ensuring all parties were well-informed of progress and outcomes.
  • Increased productivity by streamlining claim processing procedures and implementing time-saving technologies.

Patient Access Representative

Advent Health
05.2019 - 11.2021
  • Coordinated patient appointments and hospital admissions
  • Gathered information from patients, processed registration paperwork, and collected payments
  • Gave patients positive first impressions by maintaining neat lobby areas and greeting each person promptly
  • Verified and obtained required referral, authorization, or pre-certification prior to services being provided
  • Corresponded with insurance companies to process claims of patients.
  • Ensured compliance with HIPAA regulations to maintain confidentiality of sensitive patient information during all interactions.
  • Adapted quickly to changing demands within the healthcare environment, demonstrating flexibility and a strong commitment to quality patient care.

Education

Bachelor of Science - Bachelors in Business Administration

Valencia College
Orlando, FL
05.2025

Associate in Science (A.S.) - Medical Coding and Billing -

Kesier University
Orlando, FL
04.2023

Skills

    • Complex Claims Consulting
    • Compliance Management
    • Documentation Review
    • Customer Service
    • Insurance Claim Forms Review
    • Insurance Coverage Verification
    • Attention to Detail
      • Epic Systems
      • ICD-10 Coding
      • New Hire Training
      • Planning and coordination
      • Lesson Planning
      • Friendly, Positive Attitude
      • Teamwork and Collaboration

Timeline

Case Manager

Cardinal Health
11.2023 - Current

Insurance Claims Specialist

Orlando Health
11.2021 - 08.2023

Patient Access Representative

Advent Health
05.2019 - 11.2021

Bachelor of Science - Bachelors in Business Administration

Valencia College

Associate in Science (A.S.) - Medical Coding and Billing -

Kesier University

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Bridgette Fernandez