Janice Layana
Brandon,FL
Summary
Highly organized, detail oriented, and focused professional, with hands on experience in medical office administration, record management, administrative support, clerical functions, and client services. Experienced bilingual professional with a demonstrated history of working in a fast-paced medical device industry, medical terminology, medical records, and customer service. Skilled in Microsoft Office, ICD 10 codes/CPT codes, ensuring compliance of documentation, and critical thinking skills.
Overview
14
14
years of professional experience
Work History
Care Coordinator/Program Coordinator
Wellcare/Centene Inc.
05.2020 - Current
- Initiate authorization requests for output or input services in keeping with the prior authorization list
- Research claims inquiry specific to the department and responsibility
- Perform tasks necessary to promote member compliance
- Screen members for eligibility and benefits
- Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs
- Coordinate services with community based organizations
- Attend marketing and outreach meetings as directed to represent the plan
- Produces and mails routine CM letters and program educational material
- Data enter assessments and authorizations into the system
- Perform special projects necessary to assist in promoting member services.
Authorization Specialist
Electrostim Medical Services Inc.
12.2010 - 04.2020
- Coordinate day to day utilization of material resources to achieve company's goals, objectives, and standards of health care providing patient's durable equipment authorization to insurance companies within a timeframe
- Adhere to CMS, JCAHO, and HIPAA requirements when creating a new patient profile
- Serve as a liaison within the Authorization Department with various clinic representatives and vendors, assist with general duties such as: filing, sending faxes, creating files for new patients and updating vendor's information and assisting their needs
- Work collaboratively with insurance companies, nurse case managers, provider relations, and medical sales reps to ensure compliance with medical guidelines and approval of equipment
- Review and interpret medical notes for conservative treatment and muscle atrophy due injuries
- Retrieve appropriate documents to verify eligibility and benefits of patients.
Education
Currently enrolled -
Hillsborough Community College
Graduated 2004 -
Brandon High School
Skills
- Case Management
- Documentation
- Patient Education
- Organizational Skills
- Medical terminology understanding
References
Available upon request
Timeline
Care Coordinator/Program Coordinator
Wellcare/Centene Inc.
05.2020 - Current
Authorization Specialist
Electrostim Medical Services Inc.
12.2010 - 04.2020
Currently enrolled -
Hillsborough Community College
Graduated 2004 -
Brandon High School