Jalyssa Nixon

• Processed high-volume Release of Information requests for patient medical records while ensuring accuracy, timeliness, and compliance with HIPAA regulations.
• Reviewed, validated, and fulfilled medical record requests from authorized parties, including patients, healthcare providers, and external requestors with a 48 hour turnaround time.
• Utilized electronic health record and medical records management systems to locate, verify, organize, and distribute patient documentation efficiently.
• Prioritized and completed a high volume of daily medical record requests and releases within established 48-hour turnaround time requirements.
• Performed detailed reviews of records to ensure completeness, accuracy, and appropriate disclosure before release.
• Maintained accurate tracking and documentation of completed requests to support compliance audits and operational reporting.
• Remote

• Managed a high-volume queue of incoming prior authorization requests for medical benefits, ensuring all patient and clinical information was accurate and complete.
• Verified patient eligibility, benefits, and medical necessity to facilitate timely care approvals and reduce delays.
• Reviewed clinical documentation, medical records, diagnosis codes, CPT/HCPCS codes, and treatment plans to determine whether authorization requests met medical necessity criteria.
• Utilized internal platforms, payer portals, and Salesforce Health Cloud to submit, track, and update authorization requests.
• Communicated authorization status, approvals, and denials to providers and patients while ensuring HIPAA compliance.
• Contacted provider offices to obtain missing or additional clinical information required for prior authorization processing, ensuring timely case completion.
• Managed a high-volume caseload while maintaining quality standards and meeting productivity benchmarks.
• Remote

• Provided tier-1 technical support for Apple iOS, macOS, and hardware products, consistently exceeding resolution and customer satisfaction (SAT) metrics.
• Diagnosed and resolved complex software bugs, network connectivity issues, and account security inquiries using specialized Apple diagnostic tools.
• Earned a performance-based promotion to macOS Support within three months by demonstrating exceptional technical skill, speed, and call accuracy.
• Mentored new onboarding team members on Apple system navigation, troubleshooting workflows, and effective customer communication strategies.
• Documented detailed customer interactions and technical steps in CRM software to ensure seamless issue escalation and cross-team alignment

• Managed a high volume workload of prior authorization requests for pharmacy and medical benefits, verifying member eligibility, benefits, clinical information, and required documentation.
• Reviewed clinical documentation against insurance policies, formularies, and medical necessity criteria.
• Managed inbound faxes and work queues, processing authorization requests within established turnaround times, accurately documenting approvals, pending, denials, and requests for additional clinical information in the appropriate systems.
• Identified cases requiring nurse or physician review and escalated complex or non-routine requests according to established utilization management procedures and payer guidelines.
• Matched clinical records to the appropriate member and authorization request while prioritizing cases according to urgency and date of service.
• Prepared and transmitted outbound faxes to payers containing authorization determinations, voided authorization notices, and requests for additional clinical information.
• Remote