Jesus Pacelli

• Supervise administrative operations, including patient eligibility and prior authorizations for visits and procedures.
• Manage schedules, staffing, training, and office supplies to ensure smooth daily operations.
• Lead and supervise a team of seven employees, including remote staff.
• Act as the central point of communication between physicians, administrative staff, remote operators, and contracted agencies.
• Manage practice website, EMR system, licensing updates, data reporting, and minor purchasing.
• Ensure the proper functioning of systems (EMR, phones, internet, fax), and overall office maintenance.
• Handle marketing and relationship management, including local travel and meetings with partner medical offices.
• Maintain detailed employee files, HR records, incident reports, and disciplinary documentation.

• Manage front desk operations, including greeting patients, scheduling appointments, answering inquiries, and directing individuals to appropriate services.
• Place lab orders, and coordinate with external laboratories to guarantee timely processing and follow-up.
• Analyze business performance metrics to support forecasting, strategic planning, and reporting to upper management.
• Develop and implement workflow automations to streamline administrative and clinical processes, improving efficiency, and reducing manual errors.
• Oversee and coordinate direct communication with the billing company, including monitoring claim submissions, addressing billing discrepancies, and ensuring timely reimbursement.
• Generate and review billing reports to track financial performance and identify opportunities for process improvement.

• Manage a team of 8 employees across 4 USA-based clients, including 2 pain management offices and 2 cardiology offices, overseeing daily operations and team performance.
• Manage the Prior Authorization (PA) and Insurance Verification departments, including handling PA requests for vein ablations in cardiology, ensuring compliance, and efficient processing.
• Develop and implement Standard Operating Procedures (SOPs) to standardize processes, improving productivity, and operational efficiency.
• Design and implement process automations within the PA workflow, resulting in a 30% reduction in processing time and significantly decreasing manual errors.
• Develop and track key performance indicators (KPIs), such as approval rate, which improved by 20% through continuous training, workflow optimization, and proactive denial management.
• Mentor team members in handling complex customer inquiries, delivering solutions that ensured positive outcomes and client satisfaction.
• Collaborate with USA-based clients to develop strategies that aligned with sales and service goals, fostering strong relationships and enhancing retention.

• Led a team of 3 employees for a USA-based cardiology office, including 2 patient coordinators and 1 insurance specialist, ensuring smooth operations and high-quality service delivery.
• Worked closely with cross-functional teams to streamline workflows and enhance collaboration between departments.
• Reviewed and processed prior authorization requests for medical procedures and diagnostic tests, ensuring compliance with established guidelines and timely approvals.
• Engaged in client-facing communication with USA-based clients, providing updates and maintaining strong relationships to ensure satisfaction and effective service.

• Analyzed trends in authorization denials and provided detailed reports to management to support quality improvement initiatives.
• Reviewed and processed prior authorization requests for medical procedures in accordance with established guidelines.
• Conducted insurance verifications to ensure accurate coverage information and eligibility before processing authorizations.
• Assisted healthcare providers with appeals for denied authorizations, gathering additional information and documentation to support the appeal process.

(All performed for a USA-based client)

• Reviewed and processed prior authorization (PA) requests for medical procedures including pain management treatments, in accordance with established guidelines.
• Managed authorization denials and appeals, collaborating with healthcare providers to gather necessary documentation, and support the appeal process.
• Conducted insurance verifications to ensure accurate coverage information and eligibility prior to processing PA requests.

(All performed for a USA-based client.)