Summary
Overview
Work History
Education
Skills
Timeline
Generic

Garcia Jailene

Wallington

Summary

Dynamic Precertification Coordinator at NASPI with a proven track record in expediting treatment approvals and enhancing patient satisfaction. Skilled in insurance verification and patient communication, I effectively minimized claim denials and reduced wait times, ensuring timely access to necessary services while providing compassionate support throughout the precertification process.

Overview

9
9
years of professional experience

Work History

Precertification Coordinator

NASPI
05.2024 - Current
  • Expedited treatment commencement by promptly acquiring authorizations for medically necessary services within required timeframes.
  • Reduced patient wait times for approval by diligently reviewing medical records and obtaining necessary documentation.
  • Ensured smooth communication between healthcare providers, patients, and insurance companies, resulting in timely approvals and positive experiences.
  • Minimized claim denials by accurately coding procedures according to CPT guidelines before submission for approval.
  • Elevated patient satisfaction by offering compassionate guidance and support during the often-stressful precertification process.


Call Center Representative

NASPI
09.2023 - 05.2024
  • Managed high call volumes while providing exceptional customer support and maintaining professional composure.
  • Handled escalated calls professionally, effectively resolving complex issues and ensuring client satisfaction at all times.
  • Mastered multiple software systems for seamless navigation during calls, improving efficiency and reducing hold times for customers.
  • Enhanced customer satisfaction by efficiently addressing and resolving inquiries in a timely manner.
  • Reduced average call handling time, ensuring prompt service to customers while maintaining quality interactions.
  • Delivered consistent top-notch performance under pressure during peak calling hours or challenging situations.
  • Maintained accurate patient records with diligent data entry and effective communication with healthcare professionals.
  • Maintained a high degree of professionalism and empathy during difficult calls, providing emotional support to distressed patients while addressing their concerns.
  • Prioritized urgent matters while multitasking, ensuring that critical issues were addressed promptly and accurately.

Retail Merchandiser

Acosta Sales & Marketing
06.2021 - 09.2023
  • Organized and maintained displays to achieve clean and appealing product layouts.
  • Organized store merchandise racks and displays to promote and maintain visually appealing environments.
  • Removed damaged, out-of-code, not-in-set and discontinued items from displays.
  • Boosted customer satisfaction by creating visually appealing and strategically organized merchandise displays.
  • Improved overall store aesthetics by consistently maintaining clean, well-organized merchandise displays.
  • Stocked merchandise, clearly labeling items, and arranging according to size or color.
  • Developed relationships with key store personnel to support proper product placement and visibility.
  • Managed inventory levels and product rotation to maximize sales and minimize out-of-stock items.
  • Stocked shelves to match planogram images and instructions.
  • Prevented loss of inventory by conducting thorough checks for theft or damaged goods on a regular basis.

Sales Associate

The Children's Place
05.2016 - 05.2020
  • Organized racks and shelves to maintain store visual appeal, engage customers, and promote specific merchandise.
  • Handled cash transactions efficiently while adhering to company cash handling policies, ensuring accuracy in all financial exchanges.
  • Built relationships with customers to encourage repeat business.
  • Managed returns, exchanges and refunds in accordance with store policy.
  • Answered customer questions about sizing, accessories, and merchandise care.
  • Helped customers complete purchases, locate items, and join reward programs.

Education

North Bergen High School
North Bergen, NJ

Skills

  • HIPAA compliance
  • Patient scheduling
  • Customer service
  • Patient communication
  • Prior authorization processing
  • Multitasking and organization
  • Managed the end-to-end precertification process for Workers’ Compensation patients in NY and NJ, ensuring compliance with state-specific regulations
  • Verified patient eligibility and insurance coverage before scheduling services, minimizing delays and ensuring proper authorization
  • Submitted and tracked prior authorization requests for diagnostic tests, medical procedures, and specialist referrals
  • Communicated with insurance carriers, legal representatives, medical providers, and internal departments to coordinate timely approvals
  • Maintained detailed and accurate documentation of all correspondence and authorization activity in patient management systems
  • Monitored pending cases and followed up to ensure approvals were obtained prior to service dates, reducing claim denials and billing issues
  • Acted as a liaison between patients and clinical staff, providing updates on authorization status and assisting with scheduling needs
  • Stayed current on changes in No-Fault and Workers' Compensation policies and workflows to maintain compliance and optimize efficiency
  • Managed the end-to-end precertification process for No-fault patients in NJ, ensuring compliance with state-specific regulations

Timeline

Precertification Coordinator

NASPI
05.2024 - Current

Call Center Representative

NASPI
09.2023 - 05.2024

Retail Merchandiser

Acosta Sales & Marketing
06.2021 - 09.2023

Sales Associate

The Children's Place
05.2016 - 05.2020

North Bergen High School

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