Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Heidi Nelson

Lombard,IL

Summary

Efficient Prior Authorization Specialist known for high productivity and ability to complete tasks swiftly. Possess specialized skills in insurance verification, medical coding (ICD-10 and CPT), and regulatory compliance. Excel at communication, problem-solving, and time management, ensuring smooth operation within healthcare settings.

Overview

5
5
years of professional experience

Work History

Prior Authorization Specialist

The Lombard Pharmacy
Lombard, USA
08.2021 - Current
  • Negotiated with drug manufacturers and insurance providers to obtain coverage for off-label or non-formulary medications.
  • Prepared medications for dispensing by counting, pouring, labeling, and verifying doses.
  • Maintained a clean and organized pharmacy workspace, adhering to safety and hygiene standards.
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
  • Interpreted benefit language in order to determine covered services under each plan type.
  • Provided customer service to patients and healthcare providers, answering questions related to prior authorization and insurance coverage.
  • Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
  • Trained new staff on prior authorization procedures and company policies.
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Provided customer service to patients by answering questions about medications and health-related topics.
  • Assisted pharmacists in filling prescriptions accurately and efficiently.
  • Ordered drugs from wholesalers as needed and maintained records of incoming shipments.
  • Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.
  • Operated cash registers to accept payments from customers.
  • Supported pharmacy operations by answering phone calls and directing queries appropriately.
  • Organized work areas so that everything was easily accessible when needed.
  • Monitored supply inventory and promptly submitted replenishment orders to prevent shortages.
  • Communicated effectively with doctors and insurance agencies to resolve prescription cost discrepancies.
  • Implemented and followed pharmacy protocols for medication disposal and waste management.

Server

Rosemary and Jeans Public House
Lombard, USA
06.2021 - Current
  • Circulated within assigned areas to assess and address customer needs, effectively prioritizing tasks during peak hours.
  • Stayed informed about daily specials, new menu items, promotions.
  • Set up tables in between patrons to reduce wait times.
  • Ensured that each guest was served courteously, quickly, and efficiently.
  • Completed cleaning duties by sweeping and mopping floors, vacuuming carpet and tidying up server stations.
  • Handled money transactions accurately while following company procedures for handling cash payments.
  • Cleaned tables and chairs to prepare dining area for next customers.
  • Communicated effectively with kitchen staff regarding customer allergies or special requests.
  • Served food and beverages to patrons and immediately remedied issues with orders.
  • Prepared checks, itemizing total meal costs and taxes.
  • Developed rapport with guests and assisted in generating repeat business by providing exceptional customer service.
  • Explained menu options to guests, offered suggestions and took orders for food and beverages.
  • Displayed enthusiasm and knowledge about restaurant's menu and products.
  • Assisted in the setup and breakdown of banquet tables, chairs, linens, and other equipment.
  • Collected dishes promptly after each course, cleared crumbs and glassware and maintained customer satisfaction.

Police Records Clerk

The Village of Burr Ridge
Burr Ridge, USA
11.2020 - 06.2021
  • Searched for and retrieved requested documents from archives.
  • Reviewed and updated police records to ensure accuracy of information.
  • Generated reports as needed using specialized software programs.
  • Monitored compliance with applicable laws, regulations, policies, and procedures relating to police record keeping.
  • Provided assistance to law enforcement personnel with administrative tasks related to investigations.
  • Answered phone calls and responded to emails from the public seeking information about police records.
  • Entered data into computer systems and databases to track criminal activity.
  • Performed periodic audits of all police records stored in both electronic and hard copy formats.
  • Maintained confidential documents in accordance with departmental policies.
  • Processed requests for background checks on individuals or organizations.
  • Scanned paper documents into digital format for storage purposes.
  • Responded to inquiries from other law enforcement agencies regarding criminal histories.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
  • Managed time effectively to ensure tasks were completed on schedule and deadlines were met.

Police Records Clerk

The Village of Clarendon Hills
Clarendon Hills, USA
09.2019 - 11.2020
  • Searched for and retrieved requested documents from archives.
  • Reviewed and updated police records to ensure accuracy of information.
  • Monitored compliance with applicable laws, regulations, policies, and procedures relating to police record keeping.
  • Provided assistance to law enforcement personnel with administrative tasks related to investigations.
  • Answered phone calls and responded to emails from the public seeking information about police records.
  • Entered data into computer systems and databases to track criminal activity.
  • Maintained confidential documents in accordance with departmental policies.
  • Processed requests for background checks on individuals or organizations.
  • Completed day-to-day duties accurately and efficiently.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
  • Identified needs of customers promptly and efficiently.
  • Prioritized and organized tasks to efficiently accomplish service goals.

Education

Completion of the Suburban Law Enforcement Police Academy -

College of DuPage
Glen Ellyn, IL
04.2006

Completion of the Massage Therapy Program -

Olympia College
Burr Ridge, IL
01.2006

Exercise Science/Sport Studies -

The University of Tampa
Tampa, FL
07.2002

Skills

  • Microsoft Office Application
  • Google Applications
  • Excel
  • Outlook
  • Office Administration
  • Supervisor
  • Office Management
  • Customer Service
  • LEADS
  • WEBRMS
  • Data entry
  • ICD-10 coding
  • Effective communication skills
  • Professionalism and ethics
  • Patient confidentiality compliance
  • Critical thinking
  • Process improvement strategies
  • Insurance verification
  • Prior authorization process
  • Authorizations
  • Labeling accuracy
  • Processing payments
  • Answering customer questions
  • Confidentiality and HIPAA
  • Stocking shelves
  • Prescription filling
  • Medication dispensing
  • HIPAA
  • Microsoft office
  • Record management
  • Multitasking Abilities
  • Task prioritization
  • Law enforcement procedures
  • Report writing

Languages

English

Timeline

Prior Authorization Specialist

The Lombard Pharmacy
08.2021 - Current

Server

Rosemary and Jeans Public House
06.2021 - Current

Police Records Clerk

The Village of Burr Ridge
11.2020 - 06.2021

Police Records Clerk

The Village of Clarendon Hills
09.2019 - 11.2020

Completion of the Suburban Law Enforcement Police Academy -

College of DuPage

Completion of the Massage Therapy Program -

Olympia College

Exercise Science/Sport Studies -

The University of Tampa

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Heidi Nelson