Roselyn Prasad

**** ******** ******

Sacramento, California

916-***-****

adot5k@r.postjobfree.com

Objective

Seeking a position in a challenging environment where I can apply my acquired skills and education while giving my best to an employer.

Principal Duties and Responsibilities

• Knowledge to verify eligibility & benefits for each submitted physician referral by contacting the health plans for pertinent information.

• Knowledge to process and complete authorization request forms into the company's in-house system in a consistently accurate and timely manner, as well as referring the authorization request forms to the appropriate staff members for processing.

• Accuracy in processing referrals at or above the bench-mark processing daily quota.

• Maintains communication in a timely manner, the authorization request form disposition back to the appropriate staff, physicians, and facilities.

• Maintenance in organizing & acting upon pended, denial files/cases in a timely manner to maintain designated turnaround times and physician communication.

• With courtesy, answers telephone calls coming in and from insurance companies, patients, medical facilities and staff and specialty physicians.

• Provide requested referral and network information to providers/staff in a timely manner.

• Provides and effectively communicates information to providers, nursing staff regarding referrals that are not a covered benefit and facilitate denial letters and any other issues that may arise regarding the authorization requests.

• Organizes, manages and prioritizes workload effectively with the goal of processing authorization requests within the established time frame.

• Refers patients to appropriate facilities, specialty physicians in accordance to patient’s health plan.

• Performs other duties as assigned.

• Maintains a courteous and professional demeanor in all interactions, with all persons both inside and outside the office.

Experiences:

One Community Health formerly CARES Community Health

1500 21st Street

Sacramento, CA 95818

916-***-****

Referral Coordinator

June 2014-Present

Metropolitan Pain Management Consultants

Sacramento, California

Referral /Workers Compensation Coordinator

October 2011- 2014

Family Doctors of Green Valley

Las Vegas, Nevada

Referral Coordinator- Admin Assistant

March 2005-October 2011

India /Fiji Market (Family Business)

Co-Owner /Manager

Feb 2005-December 2010

Dr. Jane Hamersely

San Francisco, California

Medical Assistant/Phlebotomist

July 1992- January 1994

Mullikin Medical Center

Daly City, California

Medical Assistant /Phlebotomist

Feb.1994-Sept.1996

International Christian School

San Francisco, California

School Secretary/Bookkeeper

December 1990- June 1992

Education

Bryman College

San Francisco, California

Certified Medical Assistant

June 1994

Balboa High School

San Francisco, California

High School Diploma

June 1992

Related Skills

• Clear and accurate knowledge of medical terminology; managed care experience and worker’s compensation processing

• Working knowledge of ICD-10 & CPT codes, Word, Excel and Scanning Technology.

• Demonstrated computer literacy, NEXT GEN, Epic and EMR Experience.

• Excellent communication skills in both oral and written modes, as well as superior telephone etiquette.

• Excellent customer services experience and proficiency.

Work Ethics

1. Maintains good customer relationships with both provider office staff and providers as well as effective and courteous communication with internal staff.

2. Effectively manages and prioritizes workflow of daily provider authorization requests and to accomplish a timely turn-around time.

3. Positively contributes to the utilization management team via effective communication and problem solving within framework established by the department.

References available upon request

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