Nyghia Edwards
Tampa,FL
Summary
Dynamic Case Manager Specialist at Amgen with a proven track record in client advocacy and treatment planning. Expert in insurance verification and patient scheduling, ensuring seamless care coordination. Recognized for enhancing patient outcomes through effective communication and meticulous documentation, driving efficiency in healthcare delivery.
Overview
5
5
years of professional experience
Work History
Case Manager Specialist
Amgen
Tampa, FL
01.2024 - Current
- Coordinated patient care plans with healthcare professionals and families.
- Preformed pre-registration and enrolment for existing and new patients
- Obtain prior authorizations for procedures and treatments from commercial and government insurance carriers.
- Contacted insurance companies via phone or internet to obtain effective date of insurance coverage, type of coverage, co-pay or co-insurance information, coverage for special drugs and procedures, PCP information if required, whether referral is required, and address for claims submission.
- Utilize insurance websites (Availity, Humana Military (Tricare), United Healthcare, etc....) to obtain insurance benefits.
- Maintained detailed records of patient treatments, ensuring accurate billing and efficient followups.
- Reviewed patient profiles to determine suitable medications in accordance with age, gender, and medical considerations.
Patient Scheduler
Call 4 Health
Tampa, FL
08.2021 - 12.2023
- Scheduled patient appointments using electronic health record systems.
- Coordinated communication between patients and healthcare providers.
- Managed patient inquiries and resolved scheduling conflicts efficiently.
- Contact patient if information we have is not correct or we are unable to verify benefits for any reason, in order to obtain accurate information prior to patient's scheduled appointment.
- Collaborate with clinical and scheduling teams to ensure seamless patient workflow.
- Analyze patient data to identify care gaps and initiate outreach based on performance metrics.Processed prescription refill requests in accordance with provider orders and prescribed medications.
Health Care Coordinator
Wipro Technologies
Tampa, FL
01.2021 - 07.2021
- Assisted healthcare team in scheduling patient appointments and coordinating referrals.
- Collaborated with medical staff to ensure effective communication and information exchange.
- Facilitated patient education on healthcare services and available resources.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Promoted a positive work environment by actively participating in team meetings and events
Education
High School Diploma -
Brandon High School
Brandon, FL06.2020
Skills
- Client advocacy
- Ethical practice
- Cultural history
- Case assessment
- Data entry and analysis
- Documentation and reporting
- Email and telephone etiquette
- Patient needs assessment
- Utilization review
- Medical records management
- Treatment Planning
- EMR / EHR
- Attention to detail
- Patient scheduling
Timeline
Case Manager Specialist
Amgen
01.2024 - Current
Patient Scheduler
Call 4 Health
08.2021 - 12.2023
Health Care Coordinator
Wipro Technologies
01.2021 - 07.2021
High School Diploma -
Brandon High School