Jackie Gaglia
Williamsville,NY
Summary
Prior Authorization Specialist with 20+ years of experience, excelling in a high-volume, fast pace environment. Expertise in navigating insurance guidelines, electronic health records, and fostering strong relationships with providers and payers to ensure seamless patient care.
Overview
16
16
years of professional experience
Work History
Prior Authorization Specialist
General Physicians
02.2024 - Current
- Reviewed and processed prior authorization requests in accordance with regulatory guidelines
- Collaborated with healthcare providers to gather necessary documentation for authorization approval
- Utilized electronic health record systems to track patient eligibility and status of requests
- Educated staff on authorization procedures, improving workflow efficiency and compliance
- Monitored authorization timelines, ensuring timely responses to expedite patient care decisions
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
Front Office Supervisor
Invision Health
07.2022 - 06.2023
- Supervised front desk to manage check-ins and check-outs.
- Helped coordinate clinical office schedules for 27 clinical staff.
- Developed and implemented office policies and procedures while adhering to HIPAA and OSHA regulations.
- Conducted staff performance evaluations to monitor progress and individual skills.
- Partnered with senior operations staff and human resources to expertly handle office or employee issues.
- Liaised with customers, addressed inquiries, handled meeting requests and answer billing questions to provide outstanding customer care.
- Maintained inventory and supply levels for contrast materials, film, catheters and other medical items, checking inventory stock and reordering items running low.
- Verified and administered employee timesheets to maintain accurate payroll.
- Managed PTO by approving, denying and processing requests.
Medical Records Specialist
General Diagnostic Associates
11.2020 - 03.2023
- Pulled patient records and transferred information to appropriate parties.
- Entered patient insurance, demographic and health information into software and confirmed records
- Maintained complete confidentiality in accordance with organization and legal requirements
- Organized patient charts, gathering medical histories, lab results and consents.
- Processed and invoiced records requests from patients, providers and third parties.
- Investigated and resolved denials and rejections with standard billing cycle timeframe.
- Applied HIPAA privacy and security regulations while handling patient information.
- Processed invoice payments and recorded information in account database.
- Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
Customer Service Supervisor
Tru-Mold Shoes
10.2017 - 06.2020
- Established positive rapport with customers, managers and customer service team members to maintain positive and successful work environment.
- Maintained knowledge of company products and services to promptly resolve complaints and concerns.
- Evaluated employee job performance and motivated staff to improve productivity.
- Responded to phone and online customer service requests within designated turnaround time to improve customer satisfaction ratings.
- Communicated with customers to assist with order placement and offer updates on status and shipping.
- Conveyed items from receiving or production areas to store in designated areas.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
Office Manager
Dr. Michael J Szalach
10.2009 - 11.2017
- Scheduled appointments, oversaw check-ins and resolved patient concerns in high-volume Podiatry practice.
- Collected information, verified insurance and collected co-payments for patients as part of check-in process.
- Called in prescription refills for patients.
- Organized and managed medical supply inventory to foster continuous availability of required items.
- Gathered patient records for provider.
- Applied knowledge of medical terminology and insurance processes to support office administration productivity.
- Retrieved faxes and uploaded documents to patient charts to assist clinical staff.
Education
GED -
University of The State of New York
Albany, NY12.2014
Skills
- Team lead
- Highly-motivated
- Complex problem solver
- Knowledge of Medical Terminology
- Electronic Medical Record (EMR)
- Customer service
- Multitasking and Organization
- Insurance verification
- Pharmacy benefit management
- Time management
- Appointment scheduling
- Prior authorization process
Professional Skills
- Medent, Eclipse, HealtheLink, Mas90, Quickbooks, Paylocity, Excel, Microsoft Word, Google Docs, Intellidose
Timeline
Prior Authorization Specialist
General Physicians
02.2024 - Current
Front Office Supervisor
Invision Health
07.2022 - 06.2023
Medical Records Specialist
General Diagnostic Associates
11.2020 - 03.2023
Customer Service Supervisor
Tru-Mold Shoes
10.2017 - 06.2020
Office Manager
Dr. Michael J Szalach
10.2009 - 11.2017
GED -
University of The State of New York