Checked member eligibility, gathered clinical records, compiled clinical data for review, processed approvals, wrote denial letters, and communicated with members about benefits, approvals, denials, medical conditions, and healthcare options.
- Managed multiple tasks, prioritizing urgent requests from physicians and nurses to ensure timely care delivery.
- Assisted in coordinating care between multiple departments effectively.
- Participated in quality improvement initiatives to enhance patient outcomes and streamline care processes.
- Advocated for patients by supporting and respecting basic rights, values, and beliefs.
- Ensured compliance with safety and health regulations consistently.
- Provided guidance to new employees regarding policies and procedures within the organization.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Worked towards departmental goals by implementing new care processes. and objectives by instituting new processes and standards for in-patient care.