Pamela Davis
Manchester
Summary
Professional and results-driven healthcare coordinator with substantial experience in pre-certification processes. Skilled in navigating complex insurance protocols, ensuring compliance, and maintaining accurate documentation. Strong focus on team collaboration, adaptability, and achieving targeted outcomes. Known for reliability, effective communication, and problem-solving abilities.
Overview
9
9
years of professional experience
Work History
Pre Certification Coordinator
Solution Health
07.2020 - Current
- Analyzed trends in certification denials to identify opportunities for process improvement, leading to increased approval rates.
- Provided exceptional customer service by promptly addressing patient inquiries regarding their pre-certification status and facilitating resolution of any issues.
- Contributed to the development and implementation of policies and procedures for the pre-certification department, ensuring compliance with industry standards.
- Reduced workflow bottlenecks by prioritizing tasks based on urgency and importance while managing multiple competing demands effectively.
- Maintained up-to-date knowledge of insurance policies and regulations, enabling accurate and efficient pre-certification submissions.
- Utilized electronic health record systems proficiently for accurate data entry, reporting, and analysis related to precertifications.
- Managed a high volume of cases simultaneously while maintaining strict attention to detail and adherence to deadlines.
- Leveraged strong organizational skills to maintain accurate records of all ongoing, pending, and completed precertifications.
Provider Appeals Representative
Nu-Life
04.2018 - 04.2020
- Obtained additional documentation required for case review.
- Prepared detailed reports summarizing appeal outcomes for management review, enabling data-driven decision-making processes within the department.
- Collaborated with cross-functional teams to ensure proper handling of complex cases, resulting in more accurate outcomes.
- Liaised with healthcare providers and insurance carriers to gather necessary documentation for appeal cases, leading to more informed decision making.
- Implemented best practices for documenting case notes, improving record-keeping accuracy, and aiding team members in tracking progress on ongoing cases.
- Achieved higher success rates on appeal cases by closely analyzing denial reasons and crafting persuasive arguments for reconsideration.
- Conducted comprehensive reviews of claim denials, identifying errors or discrepancies that led to successful reversals on appeal.
Customer Care Coordinator
Brightstar Care
01.2017 - 04.2018
- Took ownership of customers issues to follow problems through to resolution.
- Assisted call-in customers with questions and orders.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Reduced customer complaints by proactively identifying potential issues and implementing solutions.
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
- Logged call information and solutions provided into internal database.
- Conducted training and mentored team members to promote productivity and commitment to friendly service.
Customer Care Representative
United Healthcare
11.2015 - 01.2017
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Managed high call volume with exceptional professionalism and efficiency.
- Responded to customer needs through competent customer service and prompt problem-solving.
- Assisted call-in customers with questions and orders.
- Maintained a high level of product knowledge to provide accurate information and support to customers.
- Navigated multiple computer systems and applications to find information.
- Enhanced customer satisfaction by promptly addressing inquiries and resolving issues.
- Streamlined call response times for improved customer experience through effective communication techniques.
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
- Logged call information and solutions provided into internal database.
- Developed effective time management strategies to efficiently handle multiple tasks simultaneously without compromising quality.
Education
High School Diploma -
Classical High School
Lynn, MABiology
Manchester Community College
ManchesterCosmetology
Empire Beauty School
Laconia04-2006
Skills
- HIPAA compliance
- Strong organization
- Patient scheduling
- Insurance verification
- Medical terminology
- Data entry proficiency
- Healthcare industry experience
- Coverage and authorizations
- Communication and interpersonal skills
- Skilled in EPIC
- Organizational skills
- Team collaboration
Timeline
Pre Certification Coordinator
Solution Health
07.2020 - Current
Provider Appeals Representative
Nu-Life
04.2018 - 04.2020
Customer Care Coordinator
Brightstar Care
01.2017 - 04.2018
Customer Care Representative
United Healthcare
11.2015 - 01.2017
High School Diploma -
Classical High School
Biology
Manchester Community College
Cosmetology
Empire Beauty School
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