Summary
Overview
Work History
Education
Languages
Timeline
Generic

Mary Prada

Bellport,NY

Summary

Detailed-oriented and highly organized individual with a proven background as a Surgical Scheduler and Pre-authorization Specialist. Adept in navigating insurance requirements, obtaining pre-authorizations, and ensuring seamless communication between physicians, medical teams and patients. Seeking a dynamic role as a Surgical Scheduler that allows me to contribute my skills in both onsite and remote capacities. Proficient in leveraging technology for virtual coordination while maintaining precision in onsite responsibilities. Dedicated to optimizing the “patient” experience, streamlining administrative processes, and ensuring compliance with healthcare regulations. Eager to bring my dual expertise to a forward-thinking organization to enhance operational efficiency and patient satisfaction.

Overview

6
6
years of professional experience

Work History

Cardiac Cath Scheduler/Authorization Specialist

Summit Health Group (Westmed Medical Group)
08.2022 - Current
  • Interact with patients, providing them with information about their up- coming procedure, ensuring patients follow pre-operative instructions, and any necessary preparations such as fasting or medication adjustments, including completion of lab work necessary before a scheduled procedure.
  • Confirm patient demographics, insurance details, and medical history to ensure accurate and up-to-date records
  • Maintain organized and accurate records of patient appointments, procedure details, and any special requirements
  • Verify insurance coverage and obtain necessary authorizations or pre-certifications for a patients procedure.
  • Liaise with physicians and nurses to ensure all necessary resources are available for procedure.
  • Address any questions or concerns patients may have regarding scheduling or their procedure.
  • Manage any necessary rescheduling or cancellations of appointments due to unforeseen circumstances or patient requests
  • Schedule any necessary follow-up procedures after a patients cardiac catheterization procedure.
  • Always adhere to privacy regulations and maintain patient confidentiality.
  • Keep up to date with relevant medical terminology, procedures, and technologies related to cardiac catheterization.
  • Identify opportunities to streamline scheduling processes, improve patient satisfaction, and enhance overall efficiency.
  • Always prepared to handle unexpected situations or emergencies related to patient, scheduling, procedure logistics or physician requests.

Patient Care Coordinator (Prior authorization Specialist)

Optum360, United Health Group
07.2019 - 08.2022
  • Obtain precertification/authorization for procedures such as Ultrasounds, Nuclear Medicine, MRI’s and CT’s and other services as needed for internal patients and outside orders as requested by our Westmed physicians
  • Contact referring physician offices via internal messaging or phone communication when necessary to obtain pre-authorize information for proper precertification processing
  • Process external referrals who are referred by WestMed PCP’s to outside specialists
  • Resolve issues for physicians and/or clinical staff who communicate through our precert/referral STAT line and complete request effectively in a timely manner
  • Resolve issues for Contact Center agents who call on behalf of patients who communicate through our precert/referral STAT line and complete request effectively in a timely manner
  • Schedule patients on a daily basis when nuclear medicine authorizations are obtained for our Cardiologists ensuring patients receive the required tools to be prepared for their appointments
  • Constant communication with Westmed nuclear medicine radiology to ensure patients are properly scheduled and cancelled accordingly
  • Helped trained new employees in the proper procedures of outside referral format and precertification requests for outside facilities
  • Assist my fellow co-workers on a regular basis with any issues they may have regarding the precertification process or outside referrals.

Cardiac Cath Scheduler

Optum360 United Health Group
07.2019 - 08.2022
  • Interact with patients, providing them with information about their up- coming procedure, ensuring patients follow pre-operative instructions, and any necessary preparations such as fasting or medication adjustments, including completion of lab work necessary before a scheduled procedure.
  • Confirm patient demographics, insurance details, and medical history to ensure accurate and up-to-date records
  • Maintain organized and accurate records of patient appointments, procedure details, and any special requirements
  • Verify insurance coverage and obtain necessary authorizations or pre-certifications for a patients procedure.
  • Liaise with physicians and nurses to ensure all necessary resources are available for procedure.
  • Address any questions or concerns patients may have regarding scheduling or their procedure.
  • Manage any necessary rescheduling or cancellations of appointments due to unforeseen circumstances or patient requests
  • Schedule any necessary follow-up procedures after a patients cardiac catheterization procedure.
  • Always adhere to privacy regulations and maintain patient confidentiality.
  • Keep up to date with relevant medical terminology, procedures, and technologies related to cardiac catheterization.
  • Identify opportunities to streamline scheduling processes, improve patient satisfaction, and enhance overall efficiency.
  • Always prepared to handle unexpected situations or emergencies related to patient, scheduling, procedure logistics or physician requests.

Prior Authorization Specialist – In Office

WESTMED Practice Partners
08.2017 - 07.2019
  • Obtain precertification/authorization for procedures such as Ultrasounds, Nuclear Medicine, MRI’s and CT’s and other services as needed for internal patients and outside orders as requested by our Westmed physicians
  • Contact referring physician offices via internal messaging or phone communication when necessary to obtain pre-authorize information for proper precertification processing
  • Process external referrals who are referred by WestMed PCP’s to outside specialists
  • Resolve issues for physicians and/or clinical staff who communicate through our precert/referral STAT line and complete request effectively in a timely manner
  • Resolve issues for Contact Center agents who call on behalf of patients who communicate through our precert/referral STAT line and complete request effectively in a timely manner
  • Schedule patients daily when nuclear medicine authorizations are obtained for our Cardiologists ensuring patients receive the required tools to be prepared for their appointments
  • Constant communication with Westmed nuclear medicine radiology to ensure patients are properly scheduled and cancelled accordingly
  • Helped trained new employees in the proper procedures of outside referral format and precertification requests for outside facilities
  • Assist my fellow co-workers on a regular basis with any issues they may have regarding the precertification process or outside referrals.

Education

Data Entry Specialist - Certificate

Suburban Technical School
East Islip, NY
01.1992

High School Diploma -

Bellport Senior High School
Brookhaven, NY
01.1990

Languages

English
Spanish

Timeline

Cardiac Cath Scheduler/Authorization Specialist

Summit Health Group (Westmed Medical Group)
08.2022 - Current

Cardiac Cath Scheduler

Optum360 United Health Group
07.2019 - 08.2022

Patient Care Coordinator (Prior authorization Specialist)

Optum360, United Health Group
07.2019 - 08.2022

Prior Authorization Specialist – In Office

WESTMED Practice Partners
08.2017 - 07.2019

Data Entry Specialist - Certificate

Suburban Technical School

High School Diploma -

Bellport Senior High School

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Mary Prada