Nacora (Cora) Fraser
Oak Park,MI
Summary
Experienced and detail-oriented healthcare professional with strong background in leadership, administrative support, in both clinical and clerical functions. Proven ability to manage front office operations, oversee staff, and coordinate patient care processes with efficiency and professionalism. Passionate, positive, committed, and knowledgeable individual who wants to contribute to growth and development. Adept at multitasking in fast-paced environment while maintaining a focus on patient service, compliance and operational excellence.
Overview
9
9
years of professional experience
Work History
Authorization Specialist Manager
Dedicated Senior Medical Center
12.2020 - Current
- Facilitates communication, collaboration, and coordination of care. Coordinating appointments, referrals, transitions of care between primary care, specialists, hospitals, and other healthcare settings, ensuring seamless transitions and continuity of care.
- Manage and facilitates all prior authorization process in alignment with payer-specific guidelines, including,Medicaid,Medicare, and other payer types.
- Analyze and evaluate denial claims and coordinate with revenue team to resolve discrepancies. Oversees payment processing for Medical and professional claims, ensuring accuracy and adherence to regulatory guidelines.
- Managed high-volume inbound calls, scheduled patient appointments, and maintained workflow efficiency in fast paced medical environment.
- Ensured compliance with pre-admission authorization procedures are in alignment with HMO and PPO payer requirement.
- Coordinates and finalize claims handling for appeals, reconsideration requests, and investigation.
- Manages communication via fax, email, and debt collection inquiries in a timely and professional manner.
- Ensures timely collection of patient financial responsibilities, including copayments and delinquent balances.
Intake/Referral Specialist
Brightstar Healthcare
09.2016 - 12.2020
- Manage and process medical billing claims accurately and efficiently.
- Review and verify patient information, including insurance coverage and authorizations
- Demonstrate and maintain knowledge of all state and regulatory guidelines by adhering to program requirements implemented by CMS (Centers for Medicaid and Medicare Services).
- Coordinate with the Prior Authorization department to confirm authorizations have been obtained; escalate denials to clinical supervisors for follow-up action.
- Assists with payment status and maintains department status reports and logs. Investigates referral denials and acts as a liaison between provider, hospital personnel, and selected payors.
- Adheres to all Medicare, Medicaid, HIPAA, insurance regulations. Operates in accordance with applicable healthcare and insurance laws.
- Performs administrative support tasks including document filing, data input, and record maintenance.
Skills
- Proficient in healthcare and productivity software, including Epic, CMS, EMR system, Microsoft Excel, Word, Outlook, and Power BI
- Insurance billing, electronic medical records
- Files and records management
- Accounts payable, Claims management
- Prior authorization processing
- Critical thinking abilities in identifying issues and implementing data driven solutions
- Demonstrates high-level business intelligence and a keen awareness of trends,challenges, and opportunities in the healthcare industry
- Knowledge in clinical care techniques and workflow Familiar with functions and protocols of clinical environment, ensuring alignment with healthcare standards
- Proficient in managing administrative support task such as email, processing faxes,handling high-volume phone calls, document handling, and clerical responsibilities
Timeline
Authorization Specialist Manager
Dedicated Senior Medical Center
12.2020 - Current
Intake/Referral Specialist
Brightstar Healthcare
09.2016 - 12.2020
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