Denise Nesbitt
Holley,NY
Summary
Passionate about the Medical Field. 10+ years experience working with patients. Experienced in providing administrative support to health care facilities and performing tasks such as maintaining patient records, updating patient Accounts, and handling all patient and facility correspondence. Bringing forth excellent customer service skills and understanding of the Medical industry and important medical terminology.
Overview
15
15
years of professional experience
Work History
Operations Manager
JMB Fitness
Fairport, NY
05.2023 - Current
- Monitored and improved efficiency of processes, team performance, and customer service.
- Managed staffing needs through recruitment, selection, onboarding and training, disciplinary action as necessary.
- Resolved customer complaints in a timely manner while ensuring customer satisfaction remains at optimal levels.
- Managed scheduling, training and inventory control.
- Oversaw financial management, budget management, accounting and payroll activities.
Prior Authorization Specialist
University of Rochester
Rochester, NY
06.2017 - 12.2023
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Educated healthcare professionals on how to properly submit a request for pre-authorization.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Maintained accurate and up-to-date records of authorization requests and outcomes in electronic health record systems.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Reviewed and processed prior authorization requests for medical procedures and medications according to established guidelines.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
Prior Authorization Specialist
Radiation Business Solutions
Joelton, TN
12.2021 - 05.2023
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Maintained accurate records of all authorization activities in the database system.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Reviewed and processed prior authorization requests for medical procedures and medications according to established guidelines.
Medical Office Secretary
Flaherty Family Medicine
Rochester, NY
09.2015 - 05.2017
- Maintained an organized filing system of patient charts and documents.
- Assisted in scheduling appointments for patients.
- Processed payments from patients using cash registers or computers.
- Greeted patients, collected personal information and verified insurance coverage.
- Answered incoming calls and responded to inquiries from patients and staff members.
- Verified that all required paperwork was completed before patient visits.
- Scanned documents into electronic format for easy retrieval later on.
- Ensured all HIPAA regulations were followed when handling confidential patient information.
- Managed patient records by entering data into a computerized system.
Ambulatory Technologist
University of Rochester Orthopaedics
Rochester, NY
09.2009 - 03.2014
- Ensured that all medical equipment was properly maintained and sterilized.
- Assisted nurses with wound care for pressure ulcers, bed sores and surgical site wounds.
- Vital Signs
- Roomed Patients
- Assisted with Sterile Procedures
- Suture/Staple Removal
- Cast/Splint Application
- Assisted and Trained Staff with Ultrasound Guided Injections
Education
Associates - Medical Assistant
Bryant And Stratton
Rochester, NY05-2007
High School Diploma -
EJ Wilson
Spencerport, NY06-2003
Skills
- Organizational Management
- Customer Service
- Financial Management
- Retail Operations Management
- Operations Monitoring
- Records Maintenance
- Knowledgeable in [Software]
- Data Entry
- Understanding of medical terms
- Medical terminology knowledge
- Insurance procedures
- Effective communication skills
- Insurance Verification
- EMR Software
- Time Management
- Team building
- Excellent Communication
- Effective Communication
Timeline
Operations Manager
JMB Fitness
05.2023 - Current
Prior Authorization Specialist
Radiation Business Solutions
12.2021 - 05.2023
Prior Authorization Specialist
University of Rochester
06.2017 - 12.2023
Medical Office Secretary
Flaherty Family Medicine
09.2015 - 05.2017
Ambulatory Technologist
University of Rochester Orthopaedics
09.2009 - 03.2014
Associates - Medical Assistant
Bryant And Stratton
High School Diploma -
EJ Wilson
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