Prior Authorization Management
Resume:
JoseDeCasanova
CustomerServiceSupervisor
*******@*****.***
SummaryofQualifications
PersonableandconscientiousCSSupervisorwith25+yearsincustomerservice management.SeekingtoutilizemyknowledgeandskillsintheareasofHealthcareand MerchantServicesProcessorCallCenterenvironmenttobecomethenextcustomerservice supervisorinyourcompany.
WorkExperience
SupportServicesSupervisor
July292024toCurrent
UKHealthCare-LexingtonKy
KeyQualifications&Responsibilities
● EnsuringthatallORA(OperatingRoomAssistance)prepareoperating roomsandworkwithOperatingRoomnursesandnursecoordinatorsto ensurethepatientisreadyforanoperation.AlsooverseeingtheAnes TechsoveralldutiesensuringtheyareworkingwiththeAnesthesiateamto makesureallnecessaryinstruments,machines,tubings,etcaresetupfor medicaloperations.
BilingualOn-SiteSpecialist
November272023toJuly192024
SurgeStaffing-LexingtonKY
KeyQualifications&Responsibilities
●Responsibleforrecruitingtemptohiredemployees;Meetingdailyexpectationsto maintainprofitmarginabove4000billablehourseachweek.Buildingrelationships withClientsandknowingtheirneedsandexpectations.FillingworkOrdersona dailybasistoensureProfitMarginsdonotfallbelowcompany’sexpectations. DailymeetingswithemployeesbyOn-Sitevisits toensuretoaddressany concerns,questions,pains,andgainstheemployeesneed. PharmaCordLLC/ProgramSupervisor
July27,2023 – November272023
PharmacordLLC,JeffersonvilleIN
KeyQualifications&Responsibilities
●ManagingandoverseeingallactivitiesofCaseManagersassistingpatients/doctors needingtoprocessapplicationsthroughourPatientAssistancePrograms.
●EnsuringthatallCaseManagersareassistingpatientswithfinancialneedsbymeansof PatientAssistancePrograms,CoPayCardAssistance;aswellasDonationsand Foundations.
●ManagedandupdatedthecustomerserviceprocessesandproceduresviaaWIKIsite.
●Providingweeklyandmonthlyoneononemeetingwithagents,providingdailyKPIsto CaseManagersaswellasprovidingthemwithcoachinganddevelopingopportunitiesto growwithinthecompany
CustomerServiceSupervisor
April212008–April52023
HeartlandPaymentSystems,JeffersonvilleIN
KeyQualifications&Responsibilities
●Effectivelysupervisingday-to-dayfront-endoperationsofabusycustomerservice department.
●Hired,trained,andmentoredtopcustomerserviceagentsandfront-endstaff.● Implementedambitiouscustomersatisfactiongoals,providingworldclassservice,and better-enabledcustomerservicestaffmemberstoeffectivelymeetthem.●Created, edited,andalteredcustomerservicestrategies,policiesandproceduresinordertomeet 97%customerservicesatisfaction.
●ManagedandupdatedthecustomerserviceprocessesandproceduresviaaWIKIsite.
●Providingweeklyandmonthlyoneononemeetingwithagents,providingdailystatsto agentsaswellasprovidingagentswithcoachinganddevelopingopportunitiestogrow withinthecompany
KeyAchievements
●Awardeda”Heartland’sHeroAward”in2016.CSTeamsselectSupervisorsfor recognitionforbeingaHeroandleadingateamtomanysuccessesduringthe2016 year.
●Awardeda“Continuing&AdvancementAward”in2019.Workingincollaborationwithan internationalteamtocreate,train,andlaunchanewcallcenterteam.
●Implementedamoreeffectivecustomeradvocatetrainingtocreatemorespecific learningopportunitiesthatfocusesonourmerchantsprocessingproducts.● Reducedcustomerservicestaffturnoverby50%.
CustomerService/FrontlineLeader-Supervisor
March2006–February2008
RxCrossRoads,LouisvilleKY
KeyQualifications&Responsibilities
●Providingleadershipandoverseeingdepartmentalactivitiesoftwentyfiveassociates.Makingsure associatesprocessincomingcallsfrompatientsneedingtoenrollinaPatientAssistanceProgram designedbymajorPharmaceuticalCompanies.
●MakingsurethatassociatesmeetorexceeddailyexpectationsincontactingHealthInsurance Companiestoconfirmpatientcoveragepriortoreviewprescriptionapplications.●Fulfilledand exceededpatientsatisfactiongoalsinaconsistentmanner.●Helpedwithtraining,tutoring newcustomerserviceassociatesafterhiringnewclasses. KeyAchievements
●Earned“FriendliestCustomerServiceSupervisor”awardforallof2007. SubrogationSpecialist
July2005–March2006
RawlingsGroup,LouisvilleKY
●ResponsibleforprovidingclaimsresolutiontoourclientssuchasHealthcareCompanies.Recovery ofpaymentsthatwerecompletedinerror.
OperationsFrontlineLeader-Supervisor
November1995–April2005
HumanaInc,LouisvilleKY
●OverseeingdepartmentalactivitiesofassociatesinseveraldepartmentssuchasDataEntryTeam; Prior Authorization of Prescriptions Team;Medicare Reimbursement Team;and overseeing 39 agentsinaSpanishteamcreatedtohandlepatientswithavarietyofmedical/hospital/pharmacy claimsandbenefitquestions.
● Meeting the objective and goals that are to be achieved in the teams when servicing calls and resolving claims,benefits,and pharmacy related issues for over 80%of the Medicare membership in the Florida area and20%ofMedicaremembersintheremainingcoasttocoast states.
●Makingsurethatassociatesmeetorexceeddailyexpectationsofaveragehandletime,availability, compliance,andqualityassurance.
KeyAchievements
●Earned“OfficeOfThePresident”awardin2004.LeadateamofMedicare Reimbursementspecialiststorecoverover$150milliondollarsinMedicareclaims processedandpaidinerror.
●Earned“StarAward”in2001forworkingincollaborationwithPharmacists;Medical Directors;andLeadershiptocreateanewPriorAuthorizationofDrugsteam. Education
AssociateinComputerScience
StarTech,CinnaminsonNJ
Graduation:1990
RelevantCoursework:CertifiedinApplicationEntryandUnderwriting.Receivedcompanytrainingon ManagerForum,PerformanceManagement,ManagingConflict,CoachingandDeveloping,Leadingfor Success,InterviewingforSelection,CoreLeadership;PrincipleofBusinessEthics,Communications Skills,AttendedyearlyFront-LineLeaderAcademieswhichincludedadditionalbusinesscourses related.
KeySkills
●ComplaintResolution
●ProblemSolver
●MultiTasker
●Abilitytodeescalatetoughcallsituations
●TeamPlayer
●EffectiveCommunicator
●Professionalphoneetiquette
●Teambuilding&Training
●Patience,empathetic;andsympathizer
●Abilitytorecognizeemotionsandpotentialeffectsonothers
●Abilitytokeepcalminstressfulsituations
●Meetingdeadlineandcompletingcomplexescalations
Languages
●English:
●Spanish:abilitytospeakandwrite
Contact this candidate