Jacqueline Scheuermann
HealthCare Prior Authorization Specialist
Marshfield,WI
Summary
Dedicated nursing professional with extensive hands-on experience in delivering high-quality patient care. Committed to enhancing patient well-being through effective collaboration with multidisciplinary medical teams and a strong focus on optimal outcomes. Proficient in medication administration, wound care, and providing compassionate emotional support, while demonstrating adaptability in dynamic healthcare environments. Holds current BLS/CPR certification and active licensing in medication management, ensuring readiness to meet diverse patient needs.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Traveling Certified Nursing Assistant
OneStaff Medical
05.2024 - Current
- Delivered high-quality care under pressure in fast-paced environments such as emergency departments or intensive care units during travel assignments.
- Evaluated patients to identify and address wounds, behavioral concerns, and medically relevant symptoms.
- Maintained strict adherence to infection control protocols to minimize the spread of illness within healthcare facilities.
- Med surgical, wound vac, blood sugar checks, bathing, feeding, and toileting, reposition patients, comfort care measures, end-of-life duties when needed, answering call lights, range of motion for patient's or assisting to complete ROM correctly
- Collaborated with fellow CNAs to develop efficient care routines that maximized productivity while maintaining a high standard of care in each facility visited during travels.
- Electronic charting, the software includes Point Click Care, Cerner, Epic
Field Representative- CTLS WI Medicaid
Gainwell Technologies LLC
12.2024 - 06.2025
- Research Resolution third party payors, providers,CWA, DHS staff
- Systems Utilization using internal software tools to research and resolve inquires effectively for CTLS Medicaid program
- Relationship building maintaining a strong working environment to all, including stakeholders
- Training and education conduct up to date experience and training for providers, DHS, CWA staff
- Kept up-to-date on industry trends, enabling informed decision-making during client engagements.
- Systems experience EMR, Interchange, EDI, Cerner, Epic, Way-star, One-base systems.
- Established strong relationships with clients, fostering trust and loyalty for ongoing business growth.
- Strong attention to details when conversing with professionals. Independent-decision making on a daily basis, with limited supervision
Medical Prior Authorization Specialist
Marshfield Clinic Health System
03.2020 - 05.2024
- Reading medical notes for radiation, and cancer treatments. Understanding the pre-treatment drugs that are needed, prior to initial treatments.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Eligibility conflicts, and able to resolve them and load new insurance for correct prior auth submissions
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Claims processing Medicare, Medicaid, Commercial lines,Work Compensation
- Experienced within Oncology, Primary care, Behavioral Health an High-End imaging. PT,OT,ST therapies
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Specialized software platform's, such as Epic, Cerner, Qnxt, On-base, Rightfax and MS Office software
Adjudication Specialist
Department of Labor and Workforce Development
04.2020 - 02.2023
- Covid Temporary Contract- Remote Setting
- Misconduct filings/adjudicated as independent party, providing information from employer and claimant
- Determined of levels of conduct if proven, using supreme court ruling for decision to allow or deny claimant
- Extensive customer service skills with difficult circumstances
- Ability to resolve issues based on original online application submitted by claimant's
- Requesting legal document's and handling correctly per state protocols
- Ability to work remotely with understanding of program's used daily
- Ability to use Webinar for hosting and receiving business meetings with state level management
- Writing skills within legal parameters to justify ruling and decision process
- Multi-tasking skills require and strong attention to detail's
Veterans Contract Call Associate
Mindlance Employment Agency
10.2019 - 11.2019
- Inbound/Outbound calls from providers, veterans, congressman
- Enhanced customer satisfaction by addressing and resolving concerns in a timely manner.
- Prior Authorization / dental and medical appointments
- Problem-solving skills, medical terminology, billing/appointment scheduling
- Process flow interpretation and development to maintain one point contact guidelines of VA contract
- Delivered exceptional quality support with empathetic communication and effective problem-solving abilities.
- Developed strong product knowledge to provide accurate assistance and confidently answer client inquiries.
- Consistently met deadlines under pressure, managing call queues effectively without sacrificing quality support provision.
Claims Analyst
Kelly Service Global, Inc.
04.2017 - 10.2018
- Maintained strict confidentiality with all personal data as per company guidelines.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
- Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
Managed Care Coordinator
Marshfield Clinic Health System
08.2014 - 10.2015
- Eligibility /Prior Authorization's/ HCPCS / Insurance posting payments commercial and government entities
- Implemented evidence-based strategies for reducing emergency department visits among high-utilization patients through proactive outreach initiatives.
- Wisconsin Medicaid-COM-HMO's regulations-PAR standards
- Ensured compliance with regulatory standards by staying current on industry best practices and incorporating them into daily operations.
- Contributed significantly towards organizational goals by constantly seeking opportunities to improve processes and outcomes.
- Developed strong working relationships with insurance companies to streamline prior authorization processes.
Clinical Coordinator-UMR Division
UnitedHealth Group
03.2008 - 10.2013
- Precertification,authorizations,claims processing/ DME cases
- Electronic claims processing on UB04, CMS1500 submission/corrections/reprocessing
- Coordinated, monitored, assigned, and documented patient and clinical care activities.
- Problem resolution skills/multi-tasking above average skills
- Team lead skills within the department cross trained for faxes, emails
- Mentored new clinical staff members for proper onboarding and orientation processes.
- Developed strong relationships with community partners to enhance support services available for patients beyond the clinical setting.
- Ensured compliance with regulatory standards and best practices through diligent oversight of clinical procedures, documentation, and staff training.
Education
Certified Nursing Assistant - Nursing
Mid-State Technical College
08.1995
Associates - Healthcare Management
University of Phoenix
09-2009
Skills
- HIPAA compliance
- Vital signs monitoring
- Critical thinking capacity
- Strong communication skills
Certification
CNA
Timeline
Field Representative- CTLS WI Medicaid
Gainwell Technologies LLC
12.2024 - 06.2025
Traveling Certified Nursing Assistant
OneStaff Medical
05.2024 - Current
Adjudication Specialist
Department of Labor and Workforce Development
04.2020 - 02.2023
Medical Prior Authorization Specialist
Marshfield Clinic Health System
03.2020 - 05.2024
Veterans Contract Call Associate
Mindlance Employment Agency
10.2019 - 11.2019
Claims Analyst
Kelly Service Global, Inc.
04.2017 - 10.2018
Managed Care Coordinator
Marshfield Clinic Health System
08.2014 - 10.2015
Clinical Coordinator-UMR Division
UnitedHealth Group
03.2008 - 10.2013
Certified Nursing Assistant - Nursing
Mid-State Technical College
Associates - Healthcare Management
University of Phoenix
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