Summary
Overview
Work History
Education
Skills
Affiliations
Accomplishments
Certification
Languages
Websites
References
Timeline
Generic

Jessica Green

El Paso,TX

Summary

Dynamic Authorizations Specialist with a proven track record at AXIS/Complete Care Partners, excelling in prior authorization and insurance verification. Adept at enhancing operational efficiency through data analysis and Excel reporting, while providing exceptional customer service and training new staff. Committed to improving patient care and streamlining processes for optimal outcomes.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Authorizations Specialist/Patient Care Coordinator

AXIS/Complete Care Partners
El Paso, TX
08.2022 - Current
  • Assisted in the development of new processes and protocols to improve operational efficiency.
  • Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
  • Processed prior authorization requests in accordance with departmental guidelines.
  • Attended continuing education seminars on topics relevant to the role such as coding changes or insurance policy updates.
  • Performed data entry into various computer systems including but not limited to EMRs and CRMs.
  • Verified insurance authorizations with payers via telephone or web-based systems.
  • Conducted training sessions for new employees regarding company policies related to the authorization process.
  • Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
  • Researched patient eligibility, coverage information, and benefit levels.
  • Analyzed denials received from third party payers to identify trends in denials and develop proactive measures for resolution.
  • Generated monthly reports detailing productivity metrics such as number of authorizations processed per day, week, month.
  • Participated in meetings with staff members from other departments such as billing and coding teams to provide clarification on policies related to authorizations.
  • Entered data into electronic medical record system accurately and efficiently.
  • Investigated discrepancies identified during audits of claims submitted for reimbursement by providers.
  • Provided emotional support and counseling to patients during difficult times.
  • Assessed patient's need for additional resources such as home health aides or durable medical equipment suppliers in order to provide appropriate level of care.
  • Performed administrative duties such as filing paperwork, answering phones, and scheduling appointments.
  • Ensured that all necessary documentation was completed accurately and submitted in a timely manner.
  • Provided compassionate support to patients and their families.
  • Followed up with discharged patients after they left the facility to ensure they were receiving adequate post-care support.
  • Provided ongoing communication with patients, families, and other healthcare providers regarding treatment plans and progress.
  • Scheduled appointments for patients and coordinated follow-up visits as needed.
  • Educated patients on proper nutrition guidelines to promote healthy lifestyle habits.
  • Compiled and maintained medical charts and reports in complex digital databases.
  • Scheduled evaluations and procedures for patients.
  • Completed insurance verifications and claim forms for patient intake and processing.
  • Collaborated with nursing staff to advocate for individual patient needs and insurance coverage.
  • Received and routed care team messages and documents to appropriate staff.
  • Assisted patients in understanding their care plans and healthcare options.
  • Tracked patient outcomes and prepared reports for healthcare providers.
  • Managed patient appointments, ensuring efficient scheduling and rescheduling as necessary.
  • Coordinated patient referrals to specialists and other healthcare services.
  • Regularly attended meetings with department heads in order to discuss any changes or updates related to policies or procedures.
  • Resolved conflicts between employees in a timely manner.
  • Scheduled shifts for employees based on workloads and customer demand.
  • Provided coaching to employees who were having difficulty meeting expectations or goals.
  • Assisted with the development of training programs for new hires.
  • Reviewed timesheets submitted by employees for accuracy and completeness before forwarding them to payroll department.
  • Performed periodic evaluations of existing workforce processes to identify areas of improvement.
  • Analyzed data from surveys conducted among staff members regarding their satisfaction levels at work.
  • Maintained accurate records of employee attendance, vacation days, sick leaves and overtime hours.
  • Organized meetings with supervisors regarding personnel issues, such as disciplinary action or job performance reviews.

Youth Care Work/Case Aide

CLJ Consulting and Contracting LLC/ Fort Bliss
El Paso, TX
03.2020 - 12.2021
  • Assisted with daily living activities such as meal preparation, shopping, transportation and medical appointments.
  • Coordinated referrals to appropriate community resources based on client needs.
  • Supported families by providing education about parenting skills and resources available in the community.
  • Assessed client needs through interviews and assessments of family dynamics, economic situation, and health status.
  • Maintained accurate records of client interactions in the agency database system.
  • Gathered information from clients regarding their financial status and living arrangements.
  • Created reports summarizing outcomes of cases handled by the agency.

Credentialing Coordinator

Intelicentrics Incorporated
Flower Mound, TX
04.2017 - 03.2018
  • Tracked changes in policy or procedure that may affect credentials of providers.
  • Reviewed and processed applications to verify accuracy of credentialing information.
  • Monitored and tracked progress of credentialing applications to ensure timely completion.
  • Analyzed data collected during the verification process to identify discrepancies.
  • Collaborated with other organizations to obtain required documents for verification purposes.
  • Managed confidential files related to each provider's credentials.
  • Evaluated new policies or procedures related to provider qualifications or licensing requirements.
  • Responded to inquiries from internal and external sources regarding credentialing status.
  • Created and maintained records for all providers in accordance with the organization's standards.
  • Prepared monthly reports summarizing status of provider credentials.
  • Maintained database of provider information, including contact details and licensure expiration dates.
  • Assisted in preparing reports related to provider data and credentialing activities.

Patient Access Registrar

Cameron Memorial Hospital
Angola, IN
08.2014 - 03.2017
  • Collaborated with other departments to ensure proper documentation was received prior to registering a patient.
  • Processed referrals to specialists ensuring appropriate authorization was obtained.
  • Greeted patients and visitors in a professional manner, providing assistance as needed.
  • Developed positive relationships with physicians, nurses, administrators, and other staff members.
  • Filed medical records, scanned documents into the system, and maintained accurate patient information.
  • Ensured all patient registration forms were completed accurately and efficiently.
  • Utilized multiple systems such as EMR and EHR software programs for entering data related to patient demographics.
  • Responded to inquiries from providers regarding insurance coverage and benefits.
  • Resolved any discrepancies between patient accounts including incorrect charges or coding errors.
  • Provided clear instructions on how to complete necessary paperwork prior to procedures taking place.
  • Inputted orders for lab tests and radiology studies following established guidelines for accuracy.
  • Maintained confidentiality of patient information in accordance with HIPAA regulations.
  • Assisted with scheduling appointments for patients via telephone or web portal.
  • Answered incoming calls from patients or providers in regards to registration questions or issues.
  • Ensured completion of discharge paperwork prior to discharge from hospital and facility.
  • Obtained necessary signatures for privacy laws and consent for treatment.
  • Processed patient responsibility estimate determined by insurance at pre-registration.

Provider Services Representative

Superior Health Plan Inc - Centene
El Paso, TX
02.2012 - 10.2013
  • Processed claims and coordinated with providers, payers, and other third parties as necessary.
  • Resolved customer complaints and escalated more complex issues to senior staff members.
  • Identified discrepancies between invoices received from providers versus payments made by the company.
  • Maintained up-to-date knowledge of products and services offered by the company.
  • Performed data entry tasks including entering patient information into electronic medical records systems.
  • Provided customer service to clients regarding their insurance coverage and billing inquiries.
  • Assisted customers in navigating the online portal for self-service requests.
  • Developed relationships with new providers by providing guidance on how to use our systems, processes, and policies.
  • Ensured all provider contracts were properly executed before initiating services or payment arrangements.
  • Verified accuracy of submitted documentation prior to processing claims or services rendered.
  • Ensured compliance with HIPAA regulations while handling confidential patient information.
  • Investigated any potential fraud cases reported by providers or insurers according to established protocols.
  • Responded promptly to emails sent by providers concerning billing inquiries or other related matters.

Education

Bachelor of Science - Interdisciplinary Studies

Perdue University Online
Fort Lauderdale, FL
01-2009

Skills

  • Prior authorization
  • Insurance verification
  • Microsoft Excel
  • Electronic medical records
  • Data entry
  • Customer service
  • Claim processing
  • Patient coordination
  • Training and development
  • Conflict resolution
  • Documentation accuracy
  • Team performance improvement
  • Coaching and mentoring
  • Risk management
  • Time management abilities
  • Authorization processing
  • Data analysis
  • Excel reporting
  • Effective communication
  • Patient assessment
  • Scheduling
  • Care planning
  • Medical terminology
  • HIPAA guidelines
  • Records maintenance
  • Report generation
  • Employee evaluation
  • Employee evaluation reports

Affiliations

  • I have a side business that lets me utilize my artistic side but creating Homecoming Mums. I love to reading, writing in my journal and sewing to relax.

Accomplishments

  • While at Cameron Memorial Community Hospital on 12/04/2015 I was given an award for Employee recognition Program for best customer Service and Satisfation. Given by the CEO - Mrs. Connie Mc Cahill.

Certification

  • Certified Electronic Billing Systems Software Biller - 11/07/2003 Signed by Chelsea Hunter and Michael Montgomery or The Hospitals of Providence is accredited by the Texas Medical Association
  • Medical Coding and Billing Specialist Associates Degree - Vista College - December 2010

Languages

English
Native/ Bilingual
Spanish
Professional

References

References available upon request.

Timeline

Authorizations Specialist/Patient Care Coordinator

AXIS/Complete Care Partners
08.2022 - Current

Youth Care Work/Case Aide

CLJ Consulting and Contracting LLC/ Fort Bliss
03.2020 - 12.2021

Credentialing Coordinator

Intelicentrics Incorporated
04.2017 - 03.2018

Patient Access Registrar

Cameron Memorial Hospital
08.2014 - 03.2017

Provider Services Representative

Superior Health Plan Inc - Centene
02.2012 - 10.2013

Bachelor of Science - Interdisciplinary Studies

Perdue University Online

Similar Profiles

CREATE PROFILE