Fida Reen
Brooklyn,NY
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
5
5
years of professional experience
Work History
Prior Authorization Specialist
specialty infusion
08.2022 - 03.2024
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Coordinated resolutions for issues and appealed denied authorizations.
- Maintained files for referral and insurance information, entering referrals into system.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Notified ordering providers of denied authorizations.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Used nextgen to input claim, prior authorization and other important medical data into system.
- Answered questions and responded to inquiries to deliver high level of service to patients.
- Collaborated with internal departments to provide account status updates.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Maintained positive working relationship with fellow staff and management.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
- Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Informed applicants of other agencies providing useful or related assistance.
- Conducted interviews with applicants, explaining benefits process and which programs were available.
- Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
- Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
- Clarified patient inquiries and questions to update patient account information in computer system.
Networking Intern
gahur construction
01.2022 - 05.2023
- Maintained positive working relationship with fellow staff and management.
- Configured hardware devices and software settings to optimize network performance.
- Installed and repaired network fiber optic cables, Ethernet cables and other networking cabling and conduits.
- Created and updated technical documentation for network installations and changes to existing installations.
- Trained team members and users in newly implemented and emerging technology to enhance business productivity.
- Received and prioritized support requests to maximize resource utilization.
- Performed variety of clerical and administrative duties pertaining to on-site support.
Surgical Coordinator
Accord Physicians Urology Division
03.2020 - 08.2022
- Booked surgeries according to physician volume and maintained prompt turnaround times.
- Gathered current medical information and reviewed histories to gather details for surgeons.
- Distributed treatment and procedural information to patients.
- Located scheduling barriers and implemented appropriate solutions.
- Collaborated and established strong working relationships with physicians, supervisors and colleagues.
- Checked patient insurance and collected pre-authorizations from providers.
- Coordinated work processes and routed paperwork to appropriate physicians and staff members.
- Managed patient check-in and check-out procedures and processed payments.
- Scheduled follow-up appointments as designated by physician.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Arranged hospital admissions for patients as required.
- Communicated with patients with compassion while keeping medical information private.
- Scheduled tests, lab work or x-rays for patients based on physician orders.
- Scheduled and confirmed patient appointments and consultations.
- Ordered and maintained supply inventory for medical office.
- Completed relevant insurance and other claim forms.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Compiled and coded patient information or data in appropriate computer system.
- Interviewed patients to complete case histories and intake forms.
- Performed bookkeeping duties, preparing and sending financial statements or bills.
- Routed laboratory or diagnostic results to appropriate staff.
- Greeted patients, determined purpose of visit and directed to appropriate staff.
- Assisted physicians with finalizing reports, speeches or presentations.
- Transcribed recorded practitioners' diagnoses and recommendations into medical records.
- Collaborated with medical scientists to prepare reports, articles or conference presentations.
Cashier
Duane Reade
03.2019 - 06.2020
- Helped Customers find specific products, answered questions and offered advice.
- Processed returned items in accordance with store policy.
- Provided assistance with purchases, locating items and signing up for rewards programs.
- Read weekly sales inserts and monitored price changes.
- Maintained high productivity by effectively processing cash, credit, debit and voucher program payments for customers.
- Organized and maintained both physical and digital payment documentation for accurate filing and compliant recordkeeping.
- Inspected items for damage and reported issue to supervisors to return unsalable merchandise and obtain replacements for customers
- Processed customer payments quickly and returned exact change and receipts.
- Welcomed customers, offered assistance to help find necessary store items.
- Wiped down counters and conveyer belts to remove debris and maintain cleanliness.
- Learned roles of other departments to provide coverage and keep store operational.
- Trained new team members in cash register operation, stock procedures and customer service.
Pharmacy Technician
Duane Reade
03.2019 - 06.2020
- Assisted patients in minimizing medical expenses by recommending generic alternative prescription medications.
- Processed over 100 prescriptions per day in busy pharmacy achieving decreased customer wait times and maintaining excellent customer satisfaction.
- Counted, measured and compounded medications following standard procedures.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Reviewed and verified customer information and insurance provider information.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Communicated with prescribers to verify medication dosages, refill authorizations and patient information.
- Counted and labeled prescriptions with correct item and quantity.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Communicated instructions to patients or caregivers.
- Assisted pharmacist by filling prescriptions for 100 customers daily and responding to patient questions regarding prescription and medication-specific issues.
- Collected co-payments or full payments from customers.
- Processed incoming drug orders.
- Counted, measured, and compounded medications following standard procedures.
- Entered and processed patients' prescriptions into internal system.
- Located and measured medications according to prescription information, making modifications as instructed by pharmacists and providers.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Restocked automated medication dispensing equipment.
- Stocked, labeled and inventoried medication to keep accurate records.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems and locating items.
- Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
Education
High School Diploma -
Midwood High School
Brooklyn, NYBachelor of Computer Information Systems - Computers
New York City College of Technology of The City University of New York
Brooklyn, NY01.2023
Skills
- System Analysis
- Agile Development
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Terminology
- Medical Appeals Handling
- Authorizations
- Insurance Verification
- Data Entry
- HIPAA Compliance Knowledge
- Patient Referrals
- Medicare and Medicaid knowledge
- Effective communication skills
- Process improvement strategies
- Professionalism and Ethics
- Billing Procedures
- Insurance procedures
- Workflow Management
- Understanding of insurance details
- Medical terminology knowledge
- Medical Office Procedures
- Benefit Coverage
- Understanding of medical terms
- CPT coding knowledge
- Physician order verification
- Electronic Health Records Proficiency
- Utilization Review Experience
Timeline
Prior Authorization Specialist
specialty infusion
08.2022 - 03.2024
Networking Intern
gahur construction
01.2022 - 05.2023
Surgical Coordinator
Accord Physicians Urology Division
03.2020 - 08.2022
Cashier
Duane Reade
03.2019 - 06.2020
Pharmacy Technician
Duane Reade
03.2019 - 06.2020
High School Diploma -
Midwood High School
Bachelor of Computer Information Systems - Computers
New York City College of Technology of The City University of New York
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