Summary
Overview
Work History
Education
Skills
Timeline
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Stefani Paluzzi

Stefani Paluzzi

Nashville,TN

Summary

Motivated and experienced healthcare customer service professional with a strong background in authorizations processing, patient communication, and healthcare compliance. Proficient in ICD-10 coding and healthcare administration, with a commitment to improving patient satisfaction and building relationships. Adept at resolving complex issues, maintaining confidentiality, and delivering exceptional service.

Overview

11
11
years of professional experience

Work History

Marketing and Brander

Mission BBQ
02.2024 - Current
  • Provide outstanding customer service by addressing inquiries, offering menu recommendations, and ensuring a positive dining experience
  • Handle customer complaints and feedback professionally and promptly
  • Participate in and support community and promotional events, including setup, execution, and teardown
  • Proactively visited an average of 120 businesses per week, engaging with key decision-makers and driving sales through face-to-face interactions.
  • Participate in training sessions to stay updated on brand standards, product knowledge, and customer service techniques
  • Help train new team members on brand values and operational procedures

Field Sales Representative

Elevance Health- Amerigroup
03.2023 - 09.2023
  • Promote Senior Services products, generating leads and conducting sales presentations.
  • Build relationships with healthcare providers to expand membership and ensure customer satisfaction.
  • Manage customer records and performed retention services for existing clients.
  • Made approximately 90 outbound phone calls, emails, and text messages per day to prospective clients.
  • Managed approximately 30 incoming calls and emails per day from customers
  • Increased sales revenue by developing and maintaining strong relationships with clients in the assigned territory.

Denials Specialist

Meridian Health
11.2018 - 03.2023
  • Track all denial data components as required by MHP and regulatory and accrediting agencies
  • Regularly provide written reports of compliance with denial notification standards
  • Draft, proofread, and send approximately 40 denial letter templates to provider and or member
  • Remain updated on all relevant regulatory and accreditation reporting requirements and policy changes
  • Function as a liaison between the Utilization Management department and the Member Services

Utilization Management Care Coordinator

Meridian Health
12.2015 - 11.2018
  • Receive, create and forward roughly 50 corporate authorization requests to appropriate licensed reviewers in accordance with state timeframes for all states and lines of business
  • Manage telephone inquiries by logging onto appropriate phone queue and handling or forwarding calls as appropriate
  • Knowledgeable of relevant state(s) and company prior authorization requirements/guidelines for Medicaid line of business

Member Benefit Coordinator

Meridian Health
07.2014 - 12.2015
  • Conduct roughly 65 inbound/outbound phone calls with members in a professional manner and maintain phone stats according to departmental goals
  • Educate members and providers on members benefits, rights and responsibilities
  • Consistently demonstrates compliance with HIPAA regulations, professional conduct and ethical practice
  • Performs accurate data entry into MHP systems and software programs
  • Assist providers and members with status authorizations and explaining processes
  • Analyzed benefits data to identify trends and make informed decisions.

Education

Associates in Radiology - Magnetic Resonance Imaging

Pulse Radiology Institute
New York, NY
06.2026

Journalism

Macomb Community College
Clinton Township, MI

Henry Ford II High School
Sterling Heights, MI
05.2009

Skills

  • Certifications: CPT, CPR, and AED, HIPAA, Medicaid, Healthcare Compliance
  • Expertise: Customer Service, Healthcare coding, Sales and Marketing, Team Building, Problem Solving, Decision Making, Insurance Verification, Member care coordination
  • Licenses: Health Insurance/Medicare licensed in Tennessee and Michigan

Timeline

Marketing and Brander

Mission BBQ
02.2024 - Current

Field Sales Representative

Elevance Health- Amerigroup
03.2023 - 09.2023

Denials Specialist

Meridian Health
11.2018 - 03.2023

Utilization Management Care Coordinator

Meridian Health
12.2015 - 11.2018

Member Benefit Coordinator

Meridian Health
07.2014 - 12.2015

Associates in Radiology - Magnetic Resonance Imaging

Pulse Radiology Institute

Journalism

Macomb Community College

Henry Ford II High School

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Stefani Paluzzi