Customer Service Prior Authorization

ZAKIYA R. CHERIF

Phone: 215-***-**** Address: Philadelphia, PA Email: *********@*****.***

PROFESSIONAL SUMMARY

Experienced customer service professional specializing in healthcare, adept at ensuring seamless lab testing coordination and fostering transparent patient communication. Proven track record in efficiently managing lab testing orders and implementing innovative solutions, such as automated tracking systems and electronic health records transition. Skilled in handling high call volumes, delivering personalized care, and staying updated on medical terminology. Expertise extends to collaborating with law enforcement for drug and alcohol detections, showcasing effective coordination and legal protocol adherence. Well-versed in administering advanced outpatient phlebotomy services, ICD-10 codes and CPT codes and overseeing medical technology functions. Eager to contribute customer relationship management, communication excellence, and service quality optimization skills to a Client Service Representative or Customer Service role.

WORK EXPERIENCE

Pre Processing Specialist (Remote) July2007-Present

Main Line Health

Review patient medical records and insurance information to obtain the necessary prior authorizations for advanced radiology procedures (MRI, CT scans, PET scans, etc.).

Contact insurance companies and healthcare providers to verify coverage, submit authorization requests, and follow up on pending requests.

Ensure timely submission of prior authorizations to prevent delays in patient care.

Schedule patient appointments for advanced radiology procedures, ensuring that all necessary information is obtained (e.g., insurance details, physician orders).

Coordinate appointment times with radiology departments and communicate any changes or cancellations to patients and healthcare teams.

Communicate effectively with patients to explain scheduling procedures, prior authorization requirements, and insurance coverage.

Follow up with patients to confirm appointments and ensure they are prepared for their radiology procedures (e.g., fasting, bringing necessary documents).

Accurately enter patient information into the scheduling system, ensuring all data is up-to-date and properly documented.

Maintain detailed records of prior authorization approvals, rejections, and follow-up actions.

Work closely with clinical teams, insurance companies, and radiology departments to resolve any authorization or scheduling issues.

Assist in troubleshooting any issues related to insurance coverage, prior authorization denials, or scheduling conflicts.

Ensure all patient information and prior authorization processes comply with HIPAA regulations and company policies.

Stay up-to-date with the latest insurance and regulatory changes related to advanced radiology procedures.

Client-Service Representative (Remote)

Main Line Health

Collaborated with 4 Main Line Health hospitals and 8 outpatient laboratories to ensure the smooth verification and processing of lab testing order requests.

Proactively communicated essential information to patients, including scheduled appointments, approved insurance coverages, and transparent discussions about out-of-pocket fees.

Established a centralized digital repository through a shared drive, expediting data access and consolidating informative documents for streamlined daily task delegation.

Implemented an automated tracking system for specimen courier services, enhancing communication channels and providing agile solutions to address errors, missed deliveries, or contaminated specimens, upholding the highest standards of service quality.

Spearheaded external communications with stakeholders and laboratory partners, securing complex testing services based on physician orders and generating comprehensive lab reports to confirm the successful acquisition of requested samples.

Managed over 100 customer calls daily, delivering personalized, high-quality care by informing patients of testing requirements, pre-procedural instructions, and expertly triaging calls to the appropriate departments.

Remained current on medical terminology to facilitate seamless cross-communications between Medical Doctors (MDs) and laboratory personnel, proactively suggesting and ordering new tests based on each patient's evolving medical needs.

Led the troubleshooting of system errors, investigated reoccurring issues, and developed an encompassing training curriculum for phlebotomists on proper specimen procurement protocols, resulting in a remarkable 70% reduction in re-collection incidents.

Played a pivotal role in the transition of patient files to electronic health records for digital transformation, encompassing the scanning of medical documents into EPIC and running consistent diagnostics to identify and rectify transfer errors.

Applied de-escalation tactics with finesse to assist patients in navigating emotional challenges, effectively addressing their concerns.

Collaborated closely with state law enforcement officials to diligently process subpoenas for drug and alcohol detections, ensuring strict adherence to legal protocols and delivering customer-centric support throughout the process.

Engaged physicians by phone, incorporated additional tests into lab processes, and promptly communicated Medicare compliance status for efficient problem resolution.

Hybrid Phlebotomist

Main Line Health

Administered advanced outpatient phlebotomy services across 4 hospital and ambulatory sites, showcasing adaptability to diverse patient demographics.

Specialized in building rapport and executing tailored drawing techniques based on patient concerns, ensuring a positive and empathetic experience for all patients.

Completed over 60 daily venipuncture procedures, demonstrating consistency and efficiency in managing tasks.

Restructured sample collection processes, emphasizing efficiency and problem-solving skills to enhance patient comfort.

Governed over 70% of medical services with a patient-centered approach, prioritizing satisfaction and innovating strategies to reduce errors.

Promoted to oversee medical technology functions, including the use of the Hemax analysis machine. Ran blood samples through specific testing processes and reported results accurately, showcasing proficiency in various tools and systems, especially in healthcare settings.

Phlebotomist July 2007 – January 2010

Main Line health

Led administrative tasks such as faxing documentation, handling e-communications, and managing medical calls, showcasing proficiency in addressing customer inquiries and providing support.

Stayed aware of departmental testing and equipment practices, showcasing the ability to offer comprehensive support, a transferable skill valuable in addressing diverse customer needs.

Maintained patient medical records and managed inventory, emphasizing accuracy and confidentiality, demonstrating a commitment to ensuring the privacy and security of customer information.

Phlebotomist July 2007 – December 2012

Mercy Hospital Philadelphia, PA

Conducted bedside blood collections for over 60 patients daily, demonstrating sensitivity and adaptability.

Ensured sample validity by strictly adhering to healthcare regulations, showcasing attention to detail and commitment to compliance.

Executed infectious control protocols with Personal Protective Equipment (PPE) use, highlighting dedication to safety and creating a risk-free environment for customers.

Managed administrative tasks, including inventory tracking, supply ordering, and document scanning. Liaised between clients and physicians, showcasing efficiency in administrative tasks and effective communication.

MORE EXPERIENCE

Customer Service Associate January 2005 – January 2007

Pitney Bowes Management Services Philadelphia, PA

Lead Customer Service / Ramp Agent July 2002 – January 2005

AirTran Airways Philadelphia, PA

Call Center Supervisor January 1999 – March 2002

New Co Services, Inc. Philadelphia, PA

EDUCATION

Delaware County Community College Media, PA

Phlebotomy Certificate May 2006

AWARDS

Shooting Star of the Year Award November 2007

Pitney Bowes Management Services Philadelphia, PA

Award of Excellent Customer Service December 2005

AirTrain Airways Philadelphia, PA

SKILLS

Customer Relationship Management

Communication Excellence

Service Quality Optimization

Lab Testing Coordination

Patient-Centric Care

Troubleshooting Expertise

Electronic Health Records Transition

De-escalation Techniques

Law Enforcement Collaboration

Outpatient Phlebotomy

Process Innovation

Administrative Efficiency

Microsoft Office Suite

Electronic Health Records (EHR)

Google Workspace

Mysis

Sunquest

Airtable

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