Evaluated prior authorization requests for accuracy and compliance with insurance guidelines.
Collaborated with healthcare providers to obtain necessary documentation for timely approvals.
Streamlined authorization workflows, enhancing departmental efficiency and reducing turnaround times.
Managed complex cases requiring detailed communication between patients and insurers for optimal outcomes.
Streamlined workflows by implementing efficient tracking systems for pending authorizations.
Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
Medical Records/Prior Authorization Manager
Relievus
01.2015 - 06.2024
Maintain all patients’ files
Complete and send medical records to attorneys, patients, other doctor’s offices, insurance companies and workman’s compensation companies
Organizing and scanning records into patient’s charts from other doctor’s offices, imaging enters and hospitals
Manage incoming faxes and mail for department
Complete Invoices for attorneys, permanency evaluations and narratives
Complete prescription refill requests from patients, pharmacies, and doctors
Complete prior authorizations for medications with various insurance companies
Complete and maintained FLMA paperwork and short-term disability.
Business Consultant/Compliance Officer
Subway World Headquarters
02.2002 - 06.2014
Business consulting with twelve years experience in planning, developing, and assisting Subway franchisees to increase sales and profits, and to operate within Subway Corporate standards
Work with 30 plus franchisees to increase sales and profits
Compliance areas\Operations analysis
Financial analysis
Advertising assisting
Problem solving
Business development
Profit and loss Reporting
Provide updated franchisee performance reports to Subway World Headquarters
Performed monthly evaluations of each location, and documentation for Subway’s legal department when needed
Supervise and assist all assigned locations to ensure compliance with Subway specifications and operations manual
Managed Field Consultants and conducting monthly staff meetings
Execute marketing programs and general business solutions resulting in increased company exposure, customer traffic, and sales
Perform evaluations within guidelines of operations manual and act as primary liaison between franchisees and Subway World Headquarters to achieve goals and to protect brand
Provide operational support for all locations throughout Southern New Jersey
Assign tasks and work with franchisees to ensure compliance with food safety procedures and quality-control guidelines
Analyzed all areas of paperwork including completing profit and loss statements to ensure all sales were recorded and accounted for
Actively work with Franchisees in ongoing customer service programs to increase sales and rapport within community
Consistently work with franchisees to maintain high levels of cleanliness, organization, storage, and sanitation of food and beverage products to ensure quality
Train franchisees to ensure adequate business planning, maximizing efficiency and productivity ordering of food, beverages, equipment, and supplies.
Subway Store Manager
Vineland and Millville
07.2001 - 02.2002
Conduct interviews, hiring, training, and staff supervision
Schedule and direct staff with daily work assignments and to resolve staff problems and concerns
Continually monitor restaurant and take appropriate action to ensure food quality and service standards are met
Minimize loss and misuse of equipment through proper restaurant supervision and staff training
Develop and maintain exceptional customer service standards
Profit optimization by control of food, beverage, and labor costs daily
Effectively manage payroll and timekeeping, including completion of proper paperwork for new hires and terminations
Careful preparation of weekly payroll to keep up with projected revenues.
Education
Some College (No Degree) - Business Administration And Management
Lewisburg Area High School Cumberland Community College
Skills
Marketing and Business Planning Courses
Business Analysis/Development Courses
Financial Profit and Loss
Financial Analysis
Microsoft Office, Microsoft Outlook, Microsoft Power Point, Microsoft Word, and Microsoft Excel
Data Analysis
Training Staff on Balancing Cash Drawers
Evaluations
Marketing, Business Plans
Remodeling and Construction Supervision, Blueprints and Design Legal Documentation
Payroll
Human Resources
Scheduling
Training/ Risk Management
Public Relations, Quality Control
Timeline
Medical Records/Prior Authorization Manager
Relievus
01.2015 - 06.2024
Business Consultant/Compliance Officer
Subway World Headquarters
02.2002 - 06.2014
Subway Store Manager
Vineland and Millville
07.2001 - 02.2002
Prior Authorization Specialist
Pulse Vascular
2024 - Current
Some College (No Degree) - Business Administration And Management
Lewisburg Area High School Cumberland Community College