Jessenia Melo
Short Hills
Summary
Experienced healthcare administrator with 20 years in patient support and provider coordination. Expert in managing prior authorizations and reviewing medical documentation while maintaining electronic health records. Demonstrates strong communication skills and a commitment to meeting productivity and quality standards in fast-paced settings.
Overview
1
1
Language
10
10
years of professional experience
Work History
Prior Authorization Specialist
Memorial Sloan Kettering Hospital
New York
04.2022 - Current
- Efficiently processed prior authorization requests for patient treatments and medications.
- Contacted insurance carriers to secure authorization notifications and pre-certifications.
- Reviewed medical records to ensure compliance with insurance requirements.
- Clarified patient information through communication with healthcare providers to ensure accurate authorization processing.
- Coordinated with departments to gather necessary information for timely authorization approvals.
- Maintained precise records of authorization statuses to support compliance audits.
- Assisted in training staff on prior authorization workflows and policies.
- Scheduled peer-to-peer reviews for physicians to discuss medical necessity with insurers.
Office Coordinator
Memorial Sloan Kettering Hospital Center
New York
11.2019 - 04.2022
- Coordinated weekly clinic templates for provider scheduling.
- Scheduled imaging appointments and procedures for patients efficiently.
- Answered incoming calls and made outbound calls to patients for appointment management.
- Facilitated interdepartmental communication, improving operational workflows across departments.
- Assisted onboarding of new staff by preparing training materials and conducting orientation sessions for smoother integration.
- Updated and maintained electronic medical records, ensuring accuracy and compliance with regulatory standards.
Provider Relations Representative
1199 Seiu Benefit Funds
New York
10.2016 - 06.2019
- Facilitated communication between providers and health benefit funds, strengthening collaborative relationships and improving service delivery.
- Requested and updated provider enrollment credentialing and file information, ensuring compliance and accuracy in provider participation.
- Resolved provider inquiries regarding claims and reimbursements efficiently.
- Maintained accurate provider records within the database system to ensure reliability.
- Examined dental, vision, hospital, and medical claim histories for accuracy, enhancing quality of status reporting and reducing resolution time.
- Verified and updated member eligibility for members, spouses, and dependents consistently.
Education
Associate of Science - Nursing
Hudson County Community College
Jersey City, NJ07-2026
Skills
- Prior authorization
- Insurance verification
- Regulatory compliance
- Medical terminology
- Electronic records management
- Data management
- Patient advocacy
Languages
Spanish
Professional
Timeline
Prior Authorization Specialist
Memorial Sloan Kettering Hospital
04.2022 - Current
Office Coordinator
Memorial Sloan Kettering Hospital Center
11.2019 - 04.2022
Provider Relations Representative
1199 Seiu Benefit Funds
10.2016 - 06.2019
Associate of Science - Nursing
Hudson County Community College