Kamani Gujjar
Schenectady,NY
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over three years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
10
10
years of professional experience
Work History
UM Care Specialist
EmblemHealth
10.2020 - Current
- Responsible for the execution of the non-clinical aspects of the Utilization Management process
- Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations
- Request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures
- Work seamlessly with other interdisciplinary teams to ensure members' needs are met
- Provide confidential administrative support and assistance to the department in all aspects of daily program operations
- Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities
- Perform accurate and timely intake and data entry for all UM authorization requests and referrals for all lines of business, upon receipt of inbound utilization management requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements
- Triage cases and assign receipts to appropriate teams
- Respond to inquiries from providers, facilities and members
- Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines
- Enter and maintain documentation in the medical management workflow tool, meeting defined timeframes and performance standards
- Provide phone management for both incoming and outgoing calls
- Communicate with members and providers as required
- Perform other related projects and duties as assigned
- Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff
- Support communication and coordination with delegated entities, as necessary
Clinical Assistant
Center For Disability Services
02.2019 - Current
- Liaised with patients and addressed inquiries, appointment requests and billing questions.
- Called and faxed pharmacies to submit prescriptions and refills.
- Documented vital signs and health history for patients in clinic and hospital environments.
- Taught patients about medications, procedures, and care plan instructions.
- Obtained and documented patient medical history, vital signs and current complaints at intake.
- Oriented and trained new staff on proper procedures and policies.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Implemented care and efficiency improvements to support and enhance office operations.
- Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
Program Manager of Residential Services
Schenectady ARC
06.2013 - 01.2019
- Worked with senior care managers to coordinate team development activities and trainings.
- Oversaw staff development through in depth training, workshops, seminars and other learning opportunities.
- Organized individual referrals to obtain community services, including advocating for needs and resolving roadblocks.
- Developed and created programs and monitor effectiveness against individual participants needs.
- Recruited, interviewed and hired staff members offerings exceptional talent and brought great skills to team.
- Managed quality assurance program, including on-site evaluations, internal audits and customers surveys.
Education
Associate of Applied Science - Health Studies
Schenectady County Community College
Scotia, NY06.2023
Skills
- Phone Inquiries
- HIPAA Regulations
- Software System Skills
- Treatment Documentation
- Insurance Coordination
- Quality Assurance and Control
- Medical Terminology
- Positive Interactions
- Patient Health Information Access
- Case Notes
Timeline
UM Care Specialist
EmblemHealth
10.2020 - Current
Clinical Assistant
Center For Disability Services
02.2019 - Current
Program Manager of Residential Services
Schenectady ARC
06.2013 - 01.2019
Associate of Applied Science - Health Studies
Schenectady County Community College
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