Epic, Meditech, Alchemy, PCIS, PeopleSoft
Reliable business professional with experience in project management, process improvement, and financial analysis. Proven track record of successfully streamlining business operations and reducing costs. Dynamic professional with a proven track record at Boston Children’s Hospital, adept in data analysis and problem-solving. Excelled in enhancing process efficiency and optimizing customer experience through meticulous audit support and effective communication. Demonstrates exceptional critical thinking and a commitment to driving continuous improvement in financial and event management roles.
• Coordinate both in-network and out-of-network referrals, managing the entire process from initiation to final approval, and ensuring adherence to payer guidelines.
• Conduct comprehensive communications with various insurance payers to secure necessary authorizations and verify coverage of benefits, resolving discrepancies as needed.
• Facilitate the referral process by gathering required documentation and submitting requests, ensuring timely follow-up on pending authorizations to maintain continuity of patient care.
• Analyze denial trends and provide insights for process improvement, collaborating with the billing team to develop effective solutions that reduce future denials.
• Maintain a comprehensive database of referrals and authorizations, ensuring accurate documentation and tracking of all requests and approvals.
• Deliver high-quality customer service to support departmental operations, addressing inquiries and resolving issues efficiently.
Epic, Meditech, Alchemy, PCIS, PeopleSoft
Mosaic Power Chart
Microsoft Office Suite
ICD-9/10, CPT, and HCPCS coding systems