Summary
Overview
Work History
Education
Skills
Timeline
Generic

UNIQUE GRANT

Chicago,IL

Summary

Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Overview

9
9
years of professional experience

Work History

Program Coordinator

Centene
Chicago, IL
02.2024 - 07.2024
  • Initiate authorization requests for output or input services.
  • Research claims inquiry specific to the department and responsibility.
  • Perform tasks necessary to promote member compliance, such as verifying appointments and obtaining lab results.
  • Screen for eligibility and benefits, identify members without a PCP, and refer to Member Services.
  • Attend marketing and outreach meetings, as directed, to represent the plan.
  • Produces and mails routine CM letters and program educational material.
  • Entered assessments and authorizations into the system.

Prior Authorization Specialist

Aetna, a CVS Health
Chicago, IL
11.2018 - 04.2023
  • Processed over 50 prior authorization requests per day for a variety of behavioral health services via phone, fax, and email.
  • Input all members' data regarding claims and prior authorizations into the system accurately while maintaining confidentiality.
  • Analyzed clinical documents to determine approval of requests for authorization.
  • Provided prior authorization support for clinicians, healthcare providers, and members in accordance with payer guidelines.
  • Communicated authorization approvals, denials, and appeals information to providers and members.
  • Resolved providers' or members' concerns with the prior authorization process. Eliminating unnecessary phone transfers.
  • Extended authorizations, when treatment has been delayed for members.

Patient Scheduling Coordinator

The Chicago Lighthouse
Chicago, IL
05.2015 - 08.2016
  • Managed over 50 to 100 calls per day from a busy scheduling queue for multiple clinics.
  • Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
  • Maintained accurate patient records for proper tracking of patient history and treatment.
  • Coordinated with other departments to facilitate seamless operation and excellent patient care.
  • Maintained confidentiality of patient information to comply with HIPAA regulations and protect patient privacy.
  • Managed multiple schedules and prioritized tasks to meet the demands of a fast-paced work environment.

Education

High School Diploma -

Simeon Career Academy
Chicago, IL
06-2007

Skills

  • Problem Resolution skills
  • Effective Communication skills
  • Time Management skills
  • Detailed oriented
  • Customer service skills
  • Data Entry skills

Timeline

Program Coordinator

Centene
02.2024 - 07.2024

Prior Authorization Specialist

Aetna, a CVS Health
11.2018 - 04.2023

Patient Scheduling Coordinator

The Chicago Lighthouse
05.2015 - 08.2016

High School Diploma -

Simeon Career Academy

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