Candyce Senish
Saint Clair Shores
Summary
Accomplished Precertification Specialist with expertise in insurance verification, HIPAA compliance, and medical terminology. Proven track record in optimizing workflows and mentoring teams to enhance operational efficiency.
Overview
25
25
years of professional experience
Work History
Precertification Specialist
Northeast Surgical Group, PC
Macomb, MI
01.2003 - Current
- Facilitated precertification processes for surgical procedures, ensuring compliance with insurance requirements.
- Evaluated patient medical records to determine eligibility for surgical interventions and necessary authorizations.
- Collaborated with healthcare providers to gather documentation required for timely precertification approvals.
- Processed PHI (Protected Health Imformation) which includes medical record requests, completing disability and FMLA forms as well as adhering to subpoena requests from attorneys for medical records.
- Led initiatives to optimize workflow efficiency within the precertification department, reducing turnaround times significantly.
- Mentored new hires within the department, sharing best practices for navigating complex insurance requirements and fostering a supportive team environment.
Call Center Manager
Safelite Autoglass
Livonia, MI
11.2000 - 06.2002
- Led a team of call center representatives to achieve customer satisfaction goals.
- Implemented process improvements resulting in enhanced operational efficiency and reduced response times.
- Conducted regular training sessions to improve staff performance and product knowledge.
- Followed up with customer call-backs to rate the technicians performance.
- Handled all Human Resource functions at the Livonia facility.
Education
Nursing
University of Detroit Mercy
Detroit, MINursing
Wayne State University
Detroit, MISkills
- Prior authorization
- Strong communication skills
- HIPAA compliance awareness
- Organizational growth
- Insurance verification expertise
- Medical terminology proficiency
- Knowledgeable in Aprima, Cerner, and all Microsoft applications
Timeline
Precertification Specialist
Northeast Surgical Group, PC
01.2003 - Current
Call Center Manager
Safelite Autoglass
11.2000 - 06.2002
Nursing
University of Detroit Mercy
Nursing
Wayne State University