Maria Franco
Woodway,TX
Summary
At Parallon, I excelled as a Clinical Reviewer, where my adaptability and critical thinking led to a significant reduction in review turnaround times. I enhanced review quality and streamlined processes, mentoring peers as needed and safeguarding client confidentiality without compromising productivity.
I am confident I will be a great fit to this role of a Nurse Reviewer, as I have in multiple occasions, taken on the role as needed. I have successfully been able to complete extensive stay daily’s under strict deadlines, excelling underpressure. I have had filled the role on occasions as the psych account specialist. I have handled appeals in the past successfully. I am always up to a challenge and I am able to quickly, toughly and efficiently produced extensive lengths of stay clinicals while maintain quality of my review.
These past couple of years, I have shown I can step up to the plate and handle any challenge coming my way. I have eagerly take urgent accounts and I have never missed a deadline. My clinical output has also, continued to meet and exceed requirement. I am a great asset to the team and will excel in the role as the Nurse Reviewer.
Overview
10
10
years of professional experience
Work History
Clincial Reviewer, Medicaid Eligibility & Advocacy
Parallon
02.2014 - Current
- Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy.
- Mentored junior reviewers, sharing best practices and guiding their professional growth within the organization.
- Maintained strict confidentiality with sensitive client information, adhering to industry standards and company policies.
- Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
- Supported continuous improvement initiatives by actively participating in team meetings, trainings, and workshops focused on enhancing reviewer skills and processes.
- Ensured consistency across multiple review projects by maintaining strict adherence to established protocols and procedures.
- Able to use and quickly adapt to multiple submission systems and their specific submission standards/practices
- Conducted in-depth research to strengthen the overall quality and credibility of each review.
- Contributed to the development of a knowledge base for common issues encountered during reviews, streamlining future problem-solving efforts.
- Provided input on refining internal review processes based on Authorization outcome
- Streamlined the review process through the development of standardized templates and guidelines.
- Sustained high levels of productivity under tight deadlines by efficiently using available resources and acquired expertise.
- Managed competing deadlines with efficiency.
- Participated in appeal processes
- Successfully completed extensive daily stays under strick deadlines
- Psych Experience
Education
LVN - Nursing
Everest College - Anaheim
Anaheim, CA10.2013
Skills
- Adaptability and Flexibility
- Production Deadlines
- Adobe Systems Software
- Attention to Detail
- Accuracy and Precision
- Editing and review
- Team contribution
- Critical Thinking
- Data Entry
- Clinical Writing
- Deadline Attainment
- Database Maintenance
- Work Prioritization
Timeline
Clincial Reviewer, Medicaid Eligibility & Advocacy
Parallon
02.2014 - Current
LVN - Nursing
Everest College - Anaheim