Santora Nelson
Winnsboro,SC
Summary
Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience. Hardworking and reliable Case Manager with strong ability in problem solving.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Insurance Case Manager
Palmetto Infusion Services
Columbia , SC
05.2023 - Current
- Re-verifies insurance prior to each visit for existing patients.
- Obtains re-authorization as applicable on existing patients.
- Completes the Insurance verification in CPR+ and ensures the documentation obtained from the payor's website is scanned into the patient medical record.
- Contacts case management/third party administrator/payor representative
- Understands Medicare coverage principles and requirements for denial letters.
- Identifies, coordinates/sends materials to be sent to payor source.
- Provides and documents on-going communication with payor case managers for updates/changes/authorizations.
- Complies with all federal, state, county, and municipal laws, rules, ordinances and regulations applicable to the nurse practice act in the performance of obligations herein, as well as with applicable PI policies and personnel qualifications.
Intake Specialist
Rebound Behavioral Health
Lancaster, SC
07.2020 - 05.2023
- Conducted initial intake interview to obtain client information, including biographical data, medical history, presenting problem, legal status, and other pertinent information.
- Provided crisis intervention services as needed to clients in distress.
- Reviewed referral sources for appropriateness prior to admission into program.
- Answered and logged incoming inquiries via phone, fax and email.
- Maintained positive attitude and effectively de-escalated clients during crisis situations.
- Issued, gathered and inspected intake forms to confirm correct signatures and information.
- Verified insurance eligibility, benefits and patient liabilities for defined services.
Education
Associate in Human Services -
Midlands Technical College
West Columbia, SC06-2017
Psychology
Columbia College
Columbia, SCSkills
- Client Advocacy
- Regulatory Compliance
- Case Management
- Records Management
- Organization and Multitasking
- Conflict Resolution
- Documentation and Reporting
- Patient Assessment
- Medical Records Management
- Decision-Making
- Problem-Solving
- Positive Attitude
Certification
- Certified Nursing Aide
- CPR
Timeline
Insurance Case Manager
Palmetto Infusion Services
05.2023 - Current
Intake Specialist
Rebound Behavioral Health
07.2020 - 05.2023
Associate in Human Services -
Midlands Technical College
Psychology
Columbia College
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