Fida Reen
Jersey,NJ
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.
Professional in healthcare administration with strong background in managing authorization processes. Adept at ensuring compliance, streamlining workflows, and mitigating risks. Consistent track record of fostering team collaboration and achieving results in dynamic environments. Skilled in navigating complex systems, prioritizing tasks, and maintaining high standards of accuracy and efficiency.
Diligent [Desired Position] with proven track record in navigating complex healthcare systems and ensuring timely approval of medical treatments. Successfully facilitated seamless communication between providers and insurance companies to streamline authorization processes. Demonstrated expertise in medical coding and patient advocacy.
Overview
6
6
years of professional experience
Work History
Prior Authorization Specialist
Speciality Infusion
08.2022 - Current
- 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 pre authorizations 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
Bachelor of Computer Information Systems - Computers
New York City College of Technology of The City University of New York
01.2023
Skills
- System Analysis
- Agile Development
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Terminology
- Medical Appeals Handling
- Insurance Verification
- Data Entry
- HIPAA Compliance Knowledge
- Patient Referrals
- Medicare and Medicaid knowledge
- Professionalism and Ethics
- Billing Procedures
- Insurance procedures
- Workflow Management
- Understanding of insurance details
- Medical Office Procedures
- Benefit Coverage
- Understanding of medical terms
- CPT coding knowledge
- Electronic Health Records Proficiency
- Utilization Review Experience
- Process improvement strategies
- Medical terminology knowledge
- Physician order verification
- Effective communication skills
- Authorizations
Timeline
Prior Authorization Specialist
Speciality Infusion
08.2022 - Current
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
Bachelor of Computer Information Systems - Computers
New York City College of Technology of The City University of New York
High School Diploma -
Midwood High School
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