Prior Authorization Customer Service

Jennifer Taamu

**********@*****.*** 442-***-**** Long Beach,, CA

Summary

Seasoned prior Authorization Coordinator with over 10+ years of experience efficiently handling high volumes of prior authorization requests and enhancing operational efficiency. Expert in health care compliance, customer service, and record management, known for meticulous attention to detail and dependability. Proven track record in implementing digital tracking systems and maintaining 100% compliance in audits. Expert in handling high call center inquiries, capable taking calls and providing top tier customer support to members & providers. Exceptionally adept at taking on additional tasks while under time constraints and precise when handling department inbox requests. Work Experience

LA Care Health Plan

FSR Coordinator (Remote) Long Beach, CA (Remote) Feb 2024 - Current

• Managed and organized email correspondence, maintaining a 24-48 hour response window for efficient communication tracking.

• Identified and resolved email discrepancies within a 24-48 hour period to ensure accuracy and consistency.

• Coordinated with team members to process tasks, utilizing personal spreadsheets for effective task management.

• Processed urgent pre-audit packets and Webex requests, maintaining timely updates to audit schedules and nurse calendars.

• Conducted daily reviews and research of task reports across multiple platforms to gather necessary information.

• Consolidated duplicate provider requests, streamlining communication and enhancing task efficiency.

• Initiated processes for tasks with Facility Site Review (FSR) dept. and updated monitoring spreadsheets with audit schedules.

• Reach out to Plan Partners for any audit discrepancies and updates on site review info that is missed in HDS.

• Updated Health Data Systems (HDS) with provider status changes, ensuring alignment with task comments.

• Managed provider status changes and electronic service confirmations (ESC) based on research, updating relevant spreadsheets.

• Compiled and updated periodic, annual, and initial monthly reports, collecting Site Verification Forms (SVFs) and verifying information accuracy with sites accuracy of information pertaining to sites hours and operations. Hollywood Presbyterian Medical Center (Agency)

Admitting Rep for ER Los Angeles, CA Jan 2025 - Mar 2025

• Greeted and registered patients, ensuring a welcoming and efficient check-in process.

• Verified patient demographics and insurance information to maintain accurate records.

• Collected co-pays and additional payments, facilitating smooth financial transactions.

• Assisted with paperwork and documentation to support patient care and administrative tasks. ABM Industries Inc/United Airlines

LAX Wheelchair Dispatcher Los Angeles, CA Sep 2024 - Jan 2025

• Addressed wheelchair service requests from airlines through effective phone communication.

• Entered and managed wheelchair requests in the dispatch system to ensure timely service.

• Coordinated the allocation of wheelchair agents and resources across airport locations.

• Maintained active communication with airline staff and wheelchair attendants for seamless operations.

• Developed and updated operational plans and boarding logs to enhance service efficiency.

• Ensured the availability and proper functioning of essential equipment, including wheelchairs and radios.

• Assisted passengers at various airport levels to improve their travel experience.

• Enforced safety protocols and complied with company policies to maintain operational standards.

• Prepared reports and participated in staff meetings to discuss service improvements.

• Resolved complaints and addressed issues related to wheelchair services to ensure passenger satisfaction. Molina Healthcare

Advanced Imaging Prior Authorization Coordinator (Remote) Long Beach, CA (Remote) May 2014 - Jan 2024

• Processed over 80 daily prior authorization requests and resolved in excess of 50 inquiries, ensuring adherence to compliance standards and accuracy in eligibility and benefits verification.

• Improved operational efficiency by implementing a digital tracking system that increased team productivity and facilitated rapid responses to service authorization inquiries.

• Upheld a record of 100% compliance in quarterly audits by maintaining rigorous attention to detail in record-keeping and consistently meeting healthcare regulations.

• • Streamlined correspondence management procedures, resulting in a 25% decrease in handling errors and a 30% increase in process efficiency.

• Performed meticulous reviews of written communications to extract essential information, ensuring accurate responses and proper routing to relevant departmental personnel.

• Ensured full compliance with state healthcare regulations, maintaining a record of 100% audit compliance.

• • Streamlined the prior authorization process, efficiently handling over 80 requests daily, ensuring compliance and resolving more than 50 inquiries with accuracy.

• Delivered high-quality telephone support, managing over 50 calls daily to assist members and providers, facilitating the Medicare support team's operations.

• Responded to urgent prior authorization requests, monitored treatment plans, educated patients on health conditions, and facilitated connections with healthcare providers.

• Processed member authorizations for transportation, home health, and durable medical equipment, and assessed eligibility for long-term care services.

FedEx

Package Handler Houston, TX Oct 2022 - Dec 2022

• Efficiently sorted and scanned incoming packages, ensuring their accurate distribution and timely delivery to designated areas.

• Managed the loading and unloading process, maintaining a streamlined workflow to support operational efficiency. Education

Jordan High School

Diploma Long Beach, CA Jun 2002

Skills

Prior Authorization Representative, Customer Service, Patient Care Management, Transportation Requests, Home Health Requests, Case Management, Customer Service Issue Resolution, Provider Inquiries, Healthcare Audits, Member and Provider Services, Problem Solving Competencies, Medical Terminology, Prior Authorization Specialist, Medicare Team Support, Healthcare Provider Connection, Member Prior Authorizations, DME Requests, Program Support, Team Leadership, Benefits Verification, Healthcare Compliance, Insurance Verification, Time Management, Communication Skills, Problem-Solving, Knowledge of ICD-10 and CPT Codes References

Available upon request

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