Melissa Lorenzo
Registered Nurse
Ocala
Summary
Experienced professional seeking a position with advancement opportunities that will utilize my acquired skills and qualifications to contribute to the success of the organization.
Overview
16
16
years of professional experience
Work History
UM Administration Coordinator 4
Careplus
04.2023 - Current
- Provides support to my team of 25 associates. Helping answering questions and going over process changes to ensure associates understand new processes.
- Training of new associates within my team and providing support to other teams
- Monthly Developmental sessions with each associate and monthly audits to identify areas for improvement and continued success.
- Weekly production emails-to inform associates on there weekly progress and to provide support and guadiance if associate is not meeting production goals.
- Front end errors-tracks and communicates with associates regarding necessary corrections and offer guidance to help associates comprehend the relevant processes.
- Oversee daily inventory reports-to ensure cases are not aging or at risk for falling out of compliance.
- Responding to escalation emails from providers for expediated services being requested for our members
UM Administration Coordinator 2
Careplus
10.2018 - 04.2023
- Member orgs-processing authorization request that members have made for services, verifying information with specialist and primary care physicians, obtaining clinical's, cpt codes , and icd 10 diagnosis codes.
- Phone unit-assisting providers with status of authorizations and creating authorizations
- Outreach- contacting providers for missing clinicals or information.
- Routing authorizations to be worked by techs and nurses and escalating cases to ensure they do not go out of compliance
- Running web reports and assigning web cases to techs
- Part B-working part B authorizations and approving cases based on tech override list or routing to nurse for review, going over report to ensure cases have not been misrouted and are assigned to part b team, and are within compliance
Correspondence Review Processor
Molina Healthcare
04.2017 - 10.2018
- Receiving authorizations from the Doctors office and making sure all members information is correct
- Verifying diagnosis codes
- Verifying cpt codes and fee schedules to make sure codes are payable
- Verifying providers are participating and contract is active
- Creating authorization in the system
- Running criteria in IQ to determine medical necessity
- Approving authorizations
- Sending authorizations to nurses and medical directors for review if criteria is not meet
- Calling providers office to request additional information
- Meeting daily quota’s
Member Service Agent
Molina Healthcare
11.2015 - 04.2017
- Daily member and provider interaction
- Research cpt codes
- Benefit clarification
- Co pays, deductible, max out of pocket expenses
- Medicaid and Market place knowledge
- HIPPA verification
Waitress/Accounts payable
TGI FRIDAYS /MIA
10.2011 - 11.2015
- Daily Customer interaction.
- Performed data entry.
- Meet sales requirements daily
- Invoicing and making checks payable to different vendors.
- Making sure our payments were sent on time to our suppliers.
- Making sure that our monthly expense report was on budget.
Accounts Payable/ Account Receivables
Worldwide Produce, LLC
04.2010 - 11.2012
- Performed data entry
- Handled incoming calls
- Handle any discrepancies that had to do with invoices.
- Make sure customers are paid within the 21-day contract
Education
Bachelor of Science - Nursing
Hebrew University
Miami, FL01.2022
Undergraduate - bachelor’s in nursing
Miami Reginal University
Miami, FL01.2020
High School Diploma - undefined
American Academy
Miami, FL01.2009
Skills
Experienced in the clerical field hands on professional
Strong knowledge of computer programs including Microsoft Office Suite
Fully bilingual (English and Spanish)
Peach tree, Sailor, D produce man
Qnxt, CRM, Encoder pro, Csc, Cwas
Knowledge of insurance and benefits, CMS time frames, detail oriented
Timeline
UM Administration Coordinator 4
Careplus
04.2023 - Current
UM Administration Coordinator 2
Careplus
10.2018 - 04.2023
Correspondence Review Processor
Molina Healthcare
04.2017 - 10.2018
Member Service Agent
Molina Healthcare
11.2015 - 04.2017
Waitress/Accounts payable
TGI FRIDAYS /MIA
10.2011 - 11.2015
Accounts Payable/ Account Receivables
Worldwide Produce, LLC
04.2010 - 11.2012
Undergraduate - bachelor’s in nursing
Miami Reginal University
High School Diploma - undefined
American Academy
Bachelor of Science - Nursing
Hebrew University