Jessenia Blackett

Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines

Top Performance for entire 2025

SME for OHS Census report (excel)

Cross trained building OP and IP (medical/behavioral) authorization for FL state

Trained in DCP (Discharge Planning)

Trained another Authorization representative for OHS Census

Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination

Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment

Performs data entry to maintain and update various authorization requests into utilization management system

Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer

Remains up-to-date on healthcare, authorization processes, policies and procedures

Performs other duties as assigned

Complies with all policies and standard

• Dedicated customer service professional with 13 years of experience, strong communication and problem-solving skills to enhance customer satisfaction and support growth. Committed to delivering exceptional service and building lasting relationships with members, providers and even colleagues through proactive and empathetic assistance.
• Responded to member and provider inquiries, requests, and concerns accurately and promptly to ensure satisfaction.
• Acts as the primary resolution representative for various inquiries, requests, or concerns from members and providers.
• Reduces and prevents the escalation of complaints by addressing issues during the initial contact.
• Addresses fundamental issues by conveying the necessary information regarding the assessment of member or provider needs, identifying the root cause, and determining if further assistance from other departments is required.
• Provided assistance with processing claims, obtaining prior authorizations, and handling escalated calls regarding benefits and eligibility.
• Documented all member and provider interactions in CRM systems to facilitate quality assurance and enhance performance monitoring.

• Facilitated client mobility by providing guidance on durable medical equipment products and services.
• Assessing the needs of mobility impaired patients.
• Making recommendations: Recommending ordering and supplying mobility equipment.
• Gathered client information to initiate durable medical equipment procurement process.
• Verified Medicare, Medicaid, and Advantage Plans eligibility for clients.
• Scheduled face-to-face mobility examinations for clients.
• Coordinated communication among clients, physicians, and insurers to ensure seamless service delivery.
• Delivered high-quality customer service and documented client records accurately.