Michelle Teodoro

• Reviewed and processed various authorization requests for behavioral services
• Assessed clinical documentation for medical necessity and accuracy in accordance with payer policies (Medicare, Medicaid, commercial insurance)
• Maintained detailed records of authorization outcomes and followed up with health insurances to expedite processing
• Contributed to policy updates and workflow improvements to enhance turnaround times and compliance
• Supported appeals and reconsiderations by compiling relevant clinical data and documentation

• Liaised between case managers, providers, and insurance companies for ongoing case evaluations

• Designed and implemented comprehensive training programs and materials.
• Conducted training needs analysis and implemented monthly Process Mastery Assessment to address process gap.
• Create interview questions for new hires based on the result of profiling and training needs analysis.
• Analyzed data, generated comprehensive reports, and presented findings to stakeholders, reflecting strong skills in summarizing and communicating research results.
• Managed end-to-end training delivery and stakeholder coordination, demonstrating capabilities in managing project timelines, protocols, and deliverables.
• Implemented Lean Six Sigma principles to enhance business processes, akin to developing evaluation frameworks and program logic models for research.