Authorization Specialist Prior
Resume:
Magielyn R. Galdo
*** **** ** ********, ** ***** 562-***-**** ******@******.***
Overview:
Highly motivated individual with 12 years of experience, in a fast paced, team- based environment maintaining customer satisfaction and contributing to company’s success. Reliable and driven, with strong time management and prioritization abilities
Accomplishments
Skills & Abilities
●2011 United Way Loaned Executive for Gorham Savings Bank.
●Gorham’s Greatest for Gorham Savings Bank, 2014 Nominee.
●Top Sales Referrer for Gorham Savings Bank.
●Time Management Certificate Individual Retirement Certificate.
●Principles of Banking Certificate.
●State of Maine Notary Public.
●MS Windows.
●Financial Planning and Budgeting.
●Closing Ability.
●People-Orientated.
●Excellent Time Management.
●Adaptive & Flexible.
●Proactive Problem Solver.
●Highly Organized.
EXPERIENCE:
March 2020- Present Platinum Homecare Services – Care Manager
-Build relationship with referral sources such as Skilled Nursing Facility, Provider’s office, Hospitals, Assisted living Facilities
-Conduct and arrange luncheon to promote services
Speak to client’s family regarding Plan of Care, in accordance to provider’s care plan
-Conduct employee trainings
Send invoices and collect payments
-Coordinate and arrange caregiver’s schedule
-Assist client with daily living activities including dressing, feeding, transfer and continence. -- Monitor client’s vitals and overall comfort as needed
Manage client’s medications and as well as setting up medical appointments as needed.
February 2018- March 2020 Infusion Therapy Authorization Specialist
Discuss medications, insurance and prior authorization documents with patients.
Get prior authorization approval from insurance firms.
Appeal insurance companies after prior authorization refusals.
Assess accounts for completeness and accuracy.
Follow up on missing or incorrect information so patients receive the right reimbursement.
Document account activity using correct medical and billing codes.
Process all incoming infusion therapy referrals and enter all data on to EMR’s.
Obtained precertification or predetermination as required from third-party payers.
Researched the medical policies of various payers to maximize reimbursement as well for the purpose of investigating denials.
Interacted with patients to address questions regarding their authorization or billing questions.
Provided information to patients and doctors regarding participants pharmacy benefit and drug coverage
Worked with specialty pharmacies for drug availability and delivery to ensure patient’s received care in a timely manner.
Worked with drug company sales representative such as Krystexxa, Tepezza, Ramicade, Entyvio,Tysabri, Ocrevus to ensure referrals are processed accurately and promptly.
Ensure all patients are scheduled to receive infusion therapy once authorization is received and inform patient of any co-pay responsibility
Infusion Development Manager
Working in partnership with triage nurses, authorization department and business manager to resolve issues with infusion referral such as prior authorizations, authorizations, denials, appeals, patient co-pay assistance, and access to care
Manages everyday quality control and oversees all moving parts of infusion referral process cycle from initiation to completion/maintenance of account.
-Responsible for increasing penetration and profitability in existing accounts as well as increasing market share through cold calling, prospecting, building relationships, generating new patient referrals, post referral implementation and account maintenance.
-Responsible for creating a territory sales plan and regularly assesses progress on opportunities using appropriate marketing materials and tools to convey consistent messaging across the organization.
-Frequently initiating communication with Biologics Reps to identify new opportunities within a specialty
-Successfully organize multiple, on-going work streams, internal partnerships, and growth
opportunities.
-Utilized different outlets to attract new partnerships with referring physicians including warm/cold calls daily, professional networking, and attending Pharma dinner programs.
November 2016 - February 2018 Medical Receptionist, Torrance Memorial Physician Network
●Greet patients politely and prompt. Provide any necessary instructions/directions. Follow Torrance Memorial Physician Network Customer Service Standards.
●Book, coordinate, and reschedule patient appointments as needed. Ensure proper scheduling of patients, according to Physician/NP orders.
●Obtain insurance pre-authorizations and approval for all outside procedures requested by Physician/NP.
●Demonstrate clear, open, and professional communication with patients, physicians, and clinical staff.
●Knowledge of medical practice protocols and computerized scheduling, physician management, and EMR systems.
●Knowledge of all PPO and HMO insurances and authorizations.
●Maintain strict confidentiality and adhere to all HIPPA and other governmental regulations.
October 2006 - November 2015 Branch Manager, Gorham Savings Bank
Performed a variety of financial transactions (i.e. customer transactions, opening/closing deposit accounts). Received, processed, and reviewed applications for consumer, home equity, credit card and overdraft account loans. Educate applicants on credit policies and additional loan information and documentation. Actively build and develop customer relationships.
●Grew sales and service culture through sales plans and activities.
●Improved efficiencies of the bank and made recommendations towards being the pre-eminent financial services provider to residential, small business, and non-profit organizations.
●Referrals to other lines of business such as Gorham Financial, Clark Insurance, and GSB leasing.
EDUCATION:
Father Saturnino Urios University B.S. Commerce in Management, 2001
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