Jaёlle François
Jersey City,NJ
Summary
Professional in healthcare industry with strong background in managing authorizations and ensuring compliance. Skilled in navigating complex systems, problem-solving, and maintaining accurate records. Known for effective collaboration, adaptability, and delivering results in fast-paced environments. Reliable team player with expertise in healthcare regulations, communication, and customer service.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Pre-Authorization Specialist
CAREPOINT HEALTH
Jersey City
09.2021 - 07.2025
- Effectively obtain prior authorization for In-patient, Out-patient procedures, SDS, Wound Care, RP, PET
- Appealed denied cases, and created and submitted reconsideration letter cases
- Auth Approval Rate 96%, Appel approval rate 90%
- Trained new employees on system navigation and workflow
- Communication hub between patient, healthcare providers & insurance companies
- Maintain accurate and detailed records of all communications, submissions, approvals and denials
- Knowledge of medical terminology
- PE Coordinator for Charity Care
- Stayed current with all changes in insurance policies, coding guidelines and healthcare regulations that impact prior auth requirements
- Analyzed complex cases to determine eligibility for services based on policy guidelines.
- Trained new team members on authorization protocols and system navigation.
- Streamlined workflows, reducing authorization turnaround time through improved communication with external partners.
- Collaborated with healthcare providers to clarify information and expedite authorizations.
- Trained new team members on authorization procedures and system usage.
- Implemented workflow improvements that enhanced processing speed and accuracy of authorizations.
- Monitored authorization trends to identify areas for operational efficiency enhancements.
ER Patient Access Rep.
CAREPOINT HEALTH
Bayonne, NJ
03.2018 - 09.2021
- Accurately and promptly collect all pertinent information at the initial point of registration and updated demographics and consent forms.
- Verification of all Primary, Secondary, and Private insurance, through NJMMIS, Medicare & Pear ,
- Verify patient coverage and obtain information concerning extent of benefits, co-pay & Deductible
- Ensure the proper billing process occurs, which will enhance timely cash flow and reduce the days in accounts receivable.
- PE Coordinator for Charity Care
- Streamlined communication between departments to enhance patient experience and operational efficiency.
- Managed insurance verification procedures, ensuring compliance with regulations and reducing claim denials.
- Utilized electronic health record systems to maintain accurate patient information and facilitate data retrieval.
- Provided training and support to new access representatives, fostering a collaborative team environment.
Supervisor, Patient Financial Services/ Training Manager
Newark Community Health Centers, INC.
Newark, NJ
10.2016 - 01.2018
- Ensure compliance with policies and procedures for patient registration and financial counseling
- Implement fee schedules and service charges as directed by the Director of Patient Financial Services
- Ensure that all encounters are closed daily.
- Maintain manual and automated registration systems to provide complete, timely and accurate recording and reporting of related billing information
- Establish a data entry and closing schedule for registration staff.
- Ensure compliance with all eligibility requirements for payer sources. Oversee a system for assisting clients to apply and qualify for various funding sources, including, but not limited to, Medicaid, NJ Kid Care, NJFamilyCare, charity care, and such other sources as my become available
- Keeps abreast of current trends and practices, including legal and regulatory requirements.
- At the direction of the Director of Patient Financial Services may liaison with payer sources, including managed care plans and insurance carriers, Medicaid, Medicare and other government and regulatory agencies
- At patient’s request, assist with re-selection of plans and/or PCPs.
- Supervises all front desk staff for 46 employees’: 40 Patient Service Rep’s and 6 Team Lead at 6 Satellite site
- Assist with the hiring, training and evaluation of front desk staff in accordance with NCHC policies and procedures
- Maintains appropriate front desk staffing levels and scheduling at all sites
- Ensure appropriate scheduling of patients’ appointments in accordance with clinical service protocols.
- Participate in regular review of appointment policies and recommend changes as appropriate
- All other related duties assigned.
- Coordinated training sessions on best practices for staff adherence to health protocols and standards.
- Led cross-functional meetings to address challenges and develop strategic solutions for service enhancement.
Financial Eligibility Coordinator/Team Lead
Newark Community Health Centers, INC.
Irvington, NJ
02.2014 - 10.2016
- Team Lead effectively managed 8-10 employees, created schedules, processed vacation requests, and verified them, effective coverage for the day/week
- Create weekly, and Saturday, & Quarterly schedule
- Provide support to PSR’s with handling of difficult patients, answered insurance eligibility questions
- Vet all patients to see what Insurance program they fall into, i.e. PE, LOA, Medicare, or Self-pay
- Provided approval or pending status for LOA applications and sent out letters informing them of what documents is missing
- Created new sign-in sheets for patients to accurately track number of patients coming into the Healthcare center on daily basis
- Training and scheduling training for PSR’s, Assisted in training of new computer System and new hires
- Coordinator for PE/PEPW with State of NJ
- Oversaw scheduling for training of PSR’s to attend PE/PEPW training and NJCACAA recertification
- Created Action Plan for monthly meeting with Financial manager, and CFO to resolve issues
- Performed quarterly evaluating of performance
- Communicated new policies and procedures’ to PSR’s
- Generated daily reports for billing dept., CFO, Chief Medical officers for every department
- Worked closely with site nurse mangers to ensure all patient rights are upheld, all CMT’s, LPNs, and PSR’s are working together
- Facilitated patient eligibility determinations for various health programs, ensuring compliance with regulations.
- Managed documentation and data entry in electronic health record systems to maintain accuracy and accessibility.
- Trained new staff on eligibility criteria and application procedures, enhancing team competency and efficiency.
- Led workshops for community outreach, increasing awareness of health program benefits among underserved populations.
Patient Service Rep.
Newark Community Health Centers, INC.
East Orange NJ
06.2013 - 02.2014
- Accurately and promptly collect all pertinent information at the initial point of registration and updated demographics and consent forms.
- Verification of all Primary, Secondary, and Private insurance, through NJMMIS, Medicare, Palmetto Navinet
- Verify patient coverage and obtain information concerning extent of benefits, co-pay & Ded.
- Ensure the proper billing process occurs, which will enhance timely cash flow and reduce the days in accounts receivable.
- Answers patients’ questions regarding statements, EBO, and insurance coverage.
- PE application for Pregnant Women, NJ Family Care Children and Newborns, or LOA applications
- Assisted with training of new team of PSR’s, Performed duties of supervisors/managers in their absence.
- Demonstrates knowledge of proper, safe, and efficient usage of current office equipment and policies
- Protects/observes patient confidentiality per policies and procedures.
- Facilitated patient check-in and registration processes to enhance workflow efficiency.
- Managed appointment scheduling using electronic health record systems for optimal resource allocation.
- Provided exceptional customer service, addressing patient inquiries and resolving issues promptly.
- Trained new staff on operational procedures and best practices to maintain high quality service standards.
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
Education
Medical Office Technology - Medical Terminology Medical Billing & Coding, Medical Office Management
Drake College of Business
Elizabeth, New Jersey01.2010
Skills
- Strong supervisory/leadership and interpersonal skills, computer proficiency with software packages
- HIPAA compliance
- Prior authorization processing
- Documentation and paperwork
- Documentation and reporting
- Teamwork and collaboration
- Medical terminology expertise
- Insurance verification
Certification
- NJ FAMILY CARE CERTIFIED COUNSLER
- MARKETPLACE CERTIFIED APPLICATION COUNSLER 2013-2024
- PE PEPW COORDINATOR
- RUTGERS CUSTOMER SERVICE COURSE 6.3 CREDITS
- MEGELLAN HEALTH SEMINAR
Languages
French
Limited Working
Timeline
Pre-Authorization Specialist
CAREPOINT HEALTH
09.2021 - 07.2025
ER Patient Access Rep.
CAREPOINT HEALTH
03.2018 - 09.2021
Supervisor, Patient Financial Services/ Training Manager
Newark Community Health Centers, INC.
10.2016 - 01.2018
Financial Eligibility Coordinator/Team Lead
Newark Community Health Centers, INC.
02.2014 - 10.2016
Patient Service Rep.
Newark Community Health Centers, INC.
06.2013 - 02.2014
Medical Office Technology - Medical Terminology Medical Billing & Coding, Medical Office Management
Drake College of Business