Nicole Ganter
Appleton,WI
Summary
Experienced and motivated specialist. Strong attention to detail and highly analytical. Flexibility to adapt in new and difficult circumstances. Subject matter expert regarding prior authorization criteria, formulary data, client policies, and claims configuration. Eager to participate in problem-solving initiatives. Strictly adheres to compliance guidelines and procedures. Reliable team member valued for contributions.
Overview
11
11
years of professional experience
Work History
Prior Authorization Specialist I
Navitus Health Solutions
07.2023 - Current
- Processing prior authorization requests efficiently based on turnaround time while following proper client procedures and abiding by regulatory requirements
- Communicating with healthcare providers and staff to obtain necessary clinical information and documentation for approval
- Ensuring compliance with policies set by Navitus and government regulations
- Documenting circumstances in which a set procedure or policy was not followed and notifying leadership for quality assurance
- Analyzing claims and authorization history and implementing necessary changes to restore and maintain function of utilization management
- Helping train new team members using shadow sessions, reviewing their initial work, and providing feedback and coaching, referring to process guides and agent resources
- Evaluating team workload and communicating with department leadership to monitor risks for close deadlines
Comber
Totalmed Staffing
02.2023 - 07.2023
- Temp position evaluating and sorting incoming faxes in the prior authorization queue
- Assigned faxes to correct business lines
- Marked faxes in the queue for urgency and strict turnaround time for high risk clients
Assistant General Manager
McDonald's
04.2022 - 09.2022
- Interviewed applicants
- Led orientations for new team members
- Supervised up to 20 employees at a time
- Managed crew shifts/assignments
- Trained and coached new team members and shift managers
- Managed inventory and ordered product
Social Media Specialist
Alta Resources
06.2021 - 11.2021
- Provided customer service for major living brands via social media and retailer websites
- Responded to consumer complaints, reviews, and questions
- Sent compensation and replacements per warranty conditions
Customer Service Representative
VF Corporation
12.2017 - 06.2021
- Provided customer service for major retail clothing brands
- Assisted customers via phone call, email, and live chat with order status inquiries, placing orders, and product questions
- Helped manage warranty claims and ordered replacement products and store credits
- Trained, coached, and monitored the majority of new team members for a specific brand that was my specialization
Shift Manager
McDonald's
11.2014 - 05.2017
- Supervising and managing team shifts
- Managing operations during peak hours
- Training and coaching new team members
- Performing maintenance on some machinery
- Counting drawers and making bank deposits
Education
High School Diploma -
Ashwaubenon High School
Green Bay, WI06-2015
Skills
- Data entry
- Prior authorization process
- Medical terminology
- ICD-10 coding
- HIPAA compliance
- Multitasking
- Problem-solving
- Teamwork and collaboration
- Attention to detail
- Analytical skills
Timeline
Prior Authorization Specialist I
Navitus Health Solutions
07.2023 - Current
Comber
Totalmed Staffing
02.2023 - 07.2023
Assistant General Manager
McDonald's
04.2022 - 09.2022
Social Media Specialist
Alta Resources
06.2021 - 11.2021
Customer Service Representative
VF Corporation
12.2017 - 06.2021
Shift Manager
McDonald's
11.2014 - 05.2017
High School Diploma -
Ashwaubenon High School
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