Mariella S Palaganas

Managed over 200 Patient caseloads for personal care services funded by Medicaid for family members who are elderly chronically ill or disabled and their personal care attendants.

• Developed trusting and reliable working relationships patients and their caregivers by delivering emotional supports, ongoing education for policy and procedures and effectively managing their work and pay schedules.
• Contacted Medicaid insurances for medicaid verifications, Submitted prior authorizations for ongoing personal care services.
• Exceeded Call performance parameters for outgoing and incoming calls on a daily basis.

• Scheduled office and surgical appointments. Fielded telephonic inquiries regarding authorization and preparatory details
• Reached out to insurance carriers to obtain prior authorization for testing and procedures. Facilitated insurance appeals for coverage.

• Front office and back office responsibilities, included venipuncture, physical examination tests, transcription of reports, and management of medical records .

• Obtained authorizations from multiple insurance carriers for various levels of care. Submitted clinical appeals. Audited patient charts for internal integrity

• Prepared written treatment summaries for clinical coverage reviews. Verified insurance benefits and eligibility for treatment services. Provided telephonic crisis counseling and provided treatment referrals.

• Front office responsibilities, verified insurance benefit coverage for imaging procedures, scheduled appointments, transcribed physician radiology reports.

• Front office and back office responsibilities , included administering immunizations and venipuncture. Supported duties for diagnostic and technical treatment procedures,

• Back Office duties included venipuncture, immunizations and assisted physician for treatment procedures. Called and faxed pharmacies to submit prescriptions and refills.

• Clinical Case Management reviews for prior authorizations of mental health and substance abuse services. Facilitated insurance appeals. Provided crisis intervention and risk assessments.

• Conducted intake assessments for new patients. Provided group and individual psychotherapy. Prepared treatment plans and clinical reviews for insurance coverage