Michelle Navarrete
St. Cloud,FL
Summary
Dynamic Medical Management Specialist with a proven track record at Elevance Health, excelling in Medicare compliance and bilingual communication. Expert in authorization management and clinical documentation, I thrive in fast-paced environments, ensuring seamless notification outcomes. Passionate about enhancing patient care through effective case management and team training.
Overview
21
21
years of professional experience
Work History
Medical Management Specialist
Elevance Health
Miami, FL
09.2021 - Current
- Make verbal notifications to members for expedited Medicare approvals and denials.
- Translate rationales for denials from English to Spanish for Spanish-speaking members.
- Create extension letters for members requiring more clinical information, or missing authorization information.
- Send out daily census reports to nurses, and create authorizations for new inpatient admits.
- Sort through the inpatient workbasket, attach clinical information for existing authorizations, or create new inpatient or observation authorizations when needed.
- Create QIO appeals, and send the packet with the denial letter to the contracted appeal company. Translate the denial letter from English to Spanish as needed.
- Assign inpatient cases to the corresponding nurse.
- Assist in Post-MDR process review CPT codes match that of the approval/denial from medical director.
- Create QRGs and train team in the Medicare notification process.
Surgical Coordinator
South Miami Gynecologic Oncology Group
Miami, FL
12.2009 - 09.2021
- Schedule and manage the surgical schedule for several GYN oncologists.
- Obtain surgical authorization in advance to assure no delay for the scheduled surgery date. Review and provide clinicals to nurses when authorizations were pended for review. Schedule peer to peer review with physician when a auth was denied.
- Review surgical benefits with patient. Collect deductible and or co-ins based on CPT code(s) and contracted rates with insurance company.
- Review medical history and obtain necessary medical clearance needed for patient prior to surgery date.
- Enter surgeries into EMR system for physicians to billl.
- Calling hospitals to post same day admissions for surgery.
- Coordinate with other specialists offices for dual surgery cases.
- Order any special surgical equipment needed such as C02 lasers, Myosure, etc.
- Act as lead when office supervisor was out of office assisting staff, patient complaints etc.
Breast Biopsy Coordinator
Diagnostic Center For Women
Miami, FL
08.2004 - 12.2009
- Schedule patient for breast biopsies.
- Ordered and scheduled patients for pre operative testing and medical clearances when needed.
- Prepped charts for procedure day with mammogram films, ultrasound images, obtained prior imaging from other imaging centers.
- Scheduled post operative appointments.
- Faxed medical records when referred to oncologist or for second opinions.
- Printed copies of images (films/CD's) when requested.
Skills
- Proficient in Microsoft Word, Excel, and Outlook
- Medicare compliance
- Clinical documentation
- Authorization management
- Case management
- CPT/ ICD10 coding
- Patient scheduling
- Medical terminology
- Bilingual communication
Timeline
Medical Management Specialist
Elevance Health
09.2021 - Current
Surgical Coordinator
South Miami Gynecologic Oncology Group
12.2009 - 09.2021
Breast Biopsy Coordinator
Diagnostic Center For Women
08.2004 - 12.2009
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