Nadine McCoy
Buckeye,US
Summary
Healthcare Supervisor with over 18 years of extensive expertise in medical administration and claims processing. Demonstrates leadership excellence in team management and operational efficiency, leveraging skills in insurance verification, EMR systems, and benefits administration. Passionate about enhancing patient care through innovative strategies and collaborative communication, aiming to streamline healthcare operations further.
Skilled Access Specialist with background in healthcare and customer service. Experience includes patient registration, insurance verification, and appointment scheduling. Strengths lie in understanding medical terminology, maintaining patient confidentiality, and providing exceptional customer service. Previous work has resulted in improved patient satisfaction scores and streamlined office procedures.
Overview
18
18
years of professional experience
Work History
Coverage and Access Specialist
Novartis Corp
Buckeye, US
10.2023 - Current
- Facilitate patient check-ins, enhancing scheduling accuracy and service efficiency.
- Resolve insurance queries to boost patient satisfaction and expedite claims.
- Maintain confidential patient records with precision and integrity.
- Coordinate with medical staff to improve communication and patient care.
- Implement strategies to optimize patient access and service quality.
- Drive efficient patient support operations through systematic documentation management and specialty pharmacy coordination for optimal treatment outcomes.
- Execute comprehensive insurance verification and claims resolution while ensuring accurate patient record maintenance and regulatory compliance.
- Foster seamless communication between healthcare providers, insurers, and patients to expedite care delivery and enhance service quality.
- Facilitate patient care coordination through meticulous documentation management and proactive follow-up with case management teams.
- Streamline specialty pharmacy coordination processes by implementing data-driven workflows, resulting in enhanced treatment accessibility and patient outcomes.
- Lead comprehensive insurance verification protocols while maintaining strict regulatory compliance and precise documentation standards.
Prior Authorization Admin Supervisor
CVS Health
Remote, US
05.2022 - 04.2023
- Supervised 15 agents, ensuring accurate and timely prior authorizations.
- Trained staff on new procedures, boosting productivity and attendance.
- Reduced call wait times through proactive queue management.
- Collaborated with supervisors to enhance team support strategies.
- Managed medical billing operations, ensuring accurate records and compliance.
- Implemented data-driven call queue optimization strategies for pharmacy benefits team, reducing wait times while maintaining strict quality standards.
- Developed comprehensive training modules for prior authorization procedures, resulting in improved team accuracy and operational efficiency.
- Orchestrated cross-functional initiatives to streamline workflows and enhance operational procedures across pharmacy benefits departments.
- Fostered team growth through personalized coaching and feedback sessions, strengthening prior authorization processing capabilities.
- Maintained rigorous compliance standards while managing medical billing operations and premium collections for member accounts.
- Spearheaded pharmacy benefits optimization through data-driven queue management, resulting in reduced wait times while upholding quality standards.
- Pioneered cross-departmental workflow improvements, integrating efficient operational procedures across pharmacy benefits teams.
- Implemented targeted coaching programs, enhancing team expertise in medical billing operations and premium collection processes.
- Orchestrated quality assurance protocols for prior authorization procedures, ensuring precise documentation and regulatory compliance.
- Optimized prior authorization processes by implementing data-driven queue management strategies, resulting in measurable reduction in wait times while maintaining quality standards.
- Led comprehensive staff development initiatives through personalized coaching sessions, strengthening team capabilities in prior authorization processing.
- Established robust quality assurance protocols for medical billing operations, ensuring precise documentation and regulatory compliance across departments.
Member Advocate Supervisor
Maxor National Pharmacy Services Company
Tempe, US
10.2019 - 02.2022
- Led a team of 15 agents, optimizing medical authorization processes and enhancing compliance.
- Trained staff, boosting efficiency and ensuring timely call completion for improved service.
- Collaborated with supervisors to streamline support strategies, reducing customer wait times.
- Managed payment processing and account reconciliation, maintaining supervisor certifications.
- Implemented monitoring systems, achieving high satisfaction ratings and response time improvements.
- Streamlined call queue management protocols, reducing customer wait times while maintaining high-quality service standards and operational excellence.
- Partnered with cross-functional teams to enhance operational protocols, while managing premium payment processing and maintaining supervisor certifications.
- Developed targeted coaching strategies and quality monitoring assessments, driving continuous improvement in team performance and customer satisfaction.
- Mentored inbound agents through comprehensive training initiatives, fostering professional growth and ensuring consistent service delivery standards.
- Spearheaded process optimization initiatives across medical authorization workflows, leading to substantial reductions in processing time and enhanced compliance standards.
- Analyzed call center metrics to implement data-driven improvements in queue management, resulting in measurable decreases in customer wait times.
Benefits Investigation Supervisor
McKesson
Tempe, US
08.2018 - 09.2019
- Led team to secure medication benefits, boosting authorization efficiency by over 20%.
- Trained staff in protocols, enhancing team productivity and compliance significantly.
- Managed call center operations, reducing wait times and improving satisfaction rates.
- Collaborated with management to optimize support strategies and agent development.
- Implemented automated benefits verification, expediting processes and improving accuracy.
- Spearheaded call center optimization initiatives through strategic queue management, resulting in substantial reduction in customer wait times.
- Cultivated team excellence through personalized coaching and comprehensive training programs, fostering professional development and operational expertise.
- Pioneered automated benefits verification system integration, revolutionizing authorization processes while maintaining exceptional service standards.
- Orchestrated cross-departmental initiatives to enhance operational workflows, establishing robust communication channels and performance monitoring systems.
- Streamlined benefits authorization process through enhanced team protocols, driving measurable efficiency gains and reducing processing bottlenecks.
- Optimized call center performance by implementing strategic queue management solutions, resulting in substantial customer wait time reduction.
Prior Authorization Supervisor
Rite Care Pharmacy
Dallas, US
08.2015 - 08.2018
- Oversaw insurance authorizations, ensuring compliance and optimizing cost-effective solutions.
- Trained analysts, boosting team efficiency and knowledge retention.
- Managed hiring and workflow, enhancing team productivity and cohesion.
- Monitored attendance, issuing corrective actions to maintain discipline.
- Supported billing, improving payment collection accuracy.
- Orchestrated comprehensive analyst training initiatives, integrating best practices and compliance standards to elevate team performance.
- Spearheaded workflow optimization strategies and resource allocation, fostering improved team efficiency and operational excellence.
- Implemented robust quality control measures in authorization processes, ensuring regulatory compliance and patient care standards.
- Coordinated with billing teams to optimize revenue cycles, while mentoring staff and maintaining high service standards.
- Streamlined insurance authorization protocols by implementing cross-functional validation systems, reducing processing delays and enhancing patient care delivery.
- Developed comprehensive quality assurance frameworks for authorization processes, strengthening compliance adherence and minimizing claim rejections.
Case Manager/Team Lead
Maximus Federal
Dallas, US
03.2015 - 08.2015
- Managed administrative support, ensuring compliance and confidentiality.
- Resolved complex member inquiries, verifying eligibility and coverage.
- Streamlined case management processes, enhancing operational efficiency.
- Directed team initiatives, improving service quality and interdepartmental communication.
- Mentored team members on regulatory compliance and service excellence.
- Strengthened data privacy protocols and documentation standards while managing complex member inquiries and maintaining service excellence.
- Fostered interdepartmental communication and led team initiatives to improve operational efficiency and service quality benchmarks.
- Mentored team members in healthcare compliance practices while maintaining high standards in member service and administrative support.
- Led case management optimization through systematic process evaluation, implementing streamlined workflows that enhanced team performance and member satisfaction.
- Orchestrated administrative protocols and compliance measures while managing sensitive member information and resolving complex eligibility inquiries.
- Cultivated team excellence through targeted mentoring in healthcare regulations, strengthening service standards and operational effectiveness.
Claims Representative
Blue Cross Blue Shield
Tucson, US
11.2013 - 05.2015
- Resolved member inquiries, ensuring confidentiality and compliance.
- Coordinated behavioral health referrals, improving care access.
- Verified benefits and eligibility, resolving claims efficiently.
- Maintained accurate health records, enhancing service quality.
- Collaborated with teams to streamline claims processing.
- Managed complex behavioral health authorizations while maintaining strict HIPAA compliance, ensuring accurate benefits verification and timely claims resolution.
- Facilitated seamless healthcare coordination between members and providers, optimizing treatment plan implementation and improving overall care outcomes.
- Executed comprehensive benefits verification processes while maintaining meticulous documentation of protected health information and provider credentials.
- Partnered with cross-functional teams to resolve complex eligibility inquiries and streamline authorization processes, enhancing overall member satisfaction.
- Processed high-volume healthcare authorizations while enforcing strict data security protocols and expediting claims resolution through systematic workflow enhancements.
- Streamlined behavioral health referral procedures by implementing efficient tracking systems, reducing authorization processing time and improving member care access.
Interpreter
CyraCom
Tucson, US
06.2009 - 11.2013
- Facilitated client communication, ensuring timely interpretation and improved understanding.
- Managed interactions, delivering precise language solutions under pressure.
- Supported healthcare providers with real-time interpretation, boosting patient outcomes.
- Resolved language barriers, enhancing communication accuracy in complex scenarios.
- Led concurrent interpretation sessions while maintaining confidentiality standards, delivering precise language solutions in time-sensitive medical situations.
- Bridged critical communication gaps between healthcare providers and limited English proficiency patients, ensuring accurate medical information transfer.
- Developed streamlined interpretation processes for complex medical terminology, reducing communication barriers in critical healthcare interactions.
- Fostered strong partnerships with healthcare teams while providing real-time interpretation services, contributing to improved patient understanding.
- Implemented specialized medical interpretation protocols, enhancing communication accuracy between healthcare providers and patients during critical consultations.
- Optimized multilingual service delivery through streamlined interpretation methods, reducing response times and improving patient care quality.
Customer Service Representative Supervisor
TeleTech
Tucson, US
01.2007 - 05.2009
- Supervised team, enhancing call efficiency and service standards.
- Coordinated schedules, optimizing team availability and workflow.
- Analyzed metrics, generating reports for targeted service improvements.
- Mentored representatives, fostering collaborative team environment.
- Developed quality protocols, enabling data-driven performance enhancements.
- Streamlined scheduling operations and resource allocation, reducing response times while maintaining consistent service excellence across multiple shifts.
- Fostered team development through targeted mentoring programs, facilitating knowledge sharing and building expertise in complex customer interactions.
- Redesigned quality assurance protocols to optimize service delivery, implementing data-driven solutions for enhanced customer experience.
- Orchestrated comprehensive performance monitoring system, generating actionable insights for continuous service improvements and team development.
- Led cross-functional customer service teams to implement strategic improvements in call handling processes, resulting in enhanced service delivery standards.
- Executed comprehensive performance analysis and resource allocation strategies, driving operational excellence across multiple service channels.
Education
BS - Health Science
Western Governors University
Mill Creek, UT04.2025
AA - Liberal Arts and Behavioral Science
College of the Canyons
Valencia01.2007
Skills
- Healthcare Administration
- Prior Authorization
- Claims Processing
- Team Leadership
- Medical Terminology
- Epic
- Salesforce
- Zendesk
- Microsoft Office
- Benefits Administration
- Insurance Verification
- EMR Systems
- ICD-10
- Time Management
- Team building
- Customer service
- Medical billing
- Patient care coordination
- Insurance verification
- Workflow optimization
- Data management
- Regulatory compliance
- Effective communication
- Emotional intelligence
- Risk assessment
- Detail-oriented
- System updates
- Visitor screening
- Maintaining records
- Registration and scheduling
- Patient needs assessment and referral
- Self motivation
- Knowledge of community services and programs
- Teamwork and collaboration
- Ethical conduct
- Customer support
- Patient interviewing skills
- Routing lab results
- Technical troubleshooting
- Patient education
- Investigation support
- Documentation skills
- Gathering information from patients
- Multitasking
- Billing procedures
- Attention to detail
- Case management
- Coordinate referrals
- Patient intake
- Financial needs determination
- Vital statistics documentation
Languages
- English, Native
- Arabic, Native
Timeline
Coverage and Access Specialist
Novartis Corp
10.2023 - Current
Prior Authorization Admin Supervisor
CVS Health
05.2022 - 04.2023
Member Advocate Supervisor
Maxor National Pharmacy Services Company
10.2019 - 02.2022
Benefits Investigation Supervisor
McKesson
08.2018 - 09.2019
Prior Authorization Supervisor
Rite Care Pharmacy
08.2015 - 08.2018
Case Manager/Team Lead
Maximus Federal
03.2015 - 08.2015
Claims Representative
Blue Cross Blue Shield
11.2013 - 05.2015
Interpreter
CyraCom
06.2009 - 11.2013
Customer Service Representative Supervisor
TeleTech
01.2007 - 05.2009
BS - Health Science
Western Governors University
AA - Liberal Arts and Behavioral Science
College of the Canyons