Prior Authorization Service Representative/ Customer Service Team Lead

Melissa Gagne

***************@*****.*** 334-***-**** Geneva, AL https://www.linkedin.com/in/melissa-gagne-79754214 Summary

Detail-oriented professional with 12 years of experience seeking Admin Assistant role. Proven expertise in managing high-volume communication and data entry, demonstrated through roles as Prior Authorization Specialist and Claims/Customer Service Representative. Proficient in Microsoft Teams and skilled in maintaining confidentiality and accuracy in administrative tasks.

Work Experience

Aetna, a CVS Health Company

Prior Authorization Specialist Alabama, United States Jul 2024 - Jun 2025

• Utilized Salesforce, Novologix, Medcompass, and GPS to verify member benefits and coverage, ensuring accurate processing of prior authorization requests.

• Processed prior authorization requests in compliance with company guidelines and protocols, maintaining a high level of accuracy and efficiency.

• Communicated with provider offices and hospitals to obtain necessary clarifications and approvals, facilitating timely resolutions for authorization requests.

Medtronic

Prior Authorization Specialist Remote Nov 2022 - Oct 2023

• Facilitated prior authorization processing for multiple physician practices, ensuring efficient handling of requests from initial submission through appeal approval.

• Managed over 50 inbound and outbound calls daily, coordinating effectively with patients and healthcare providers to resolve authorization queries.

• Provided accurate information on claim submission, correction, and appeal processes, contributing to streamlined communication and reduced processing errors.

Asurion

Claims/Customer Service Representative Remote Sep 2020 - Oct 2022

• Processed claims efficiently for major carriers, addressing technical issues and facilitating total replacements when necessary.

• Ensured accurate maintenance of customer information through effective database management and timely data entry.

• Assisted in mentoring new employees, contributing to team development and adherence to corporate standards. Shiftsmart

Customer Service Representative Remote Jul 2020 - Sep 2020

• Conducted outbound calls to gather data for political surveys, maintaining a high daily call volume of over 80 calls.

• Enhanced communication skills by effectively engaging with a diverse range of survey participants. Enterprise Health and Rehabilitation

Charge Nurse Enterprise, Alabama Oct 2018 - Mar 2020

• Managed the daily healthcare needs of 25 long-term care patients, ensuring high-quality patient care and safety.

• Collaborated with healthcare professionals to optimize patient treatment plans and improve overall outcomes. Wiregrass Medical Center

L.P.N. Charge Nurse Geneva, Alabama Nov 2013 - Oct 2018

• Managed care for 18 short-term rehabilitation patients, ensuring adherence to individualized treatment plans and optimizing patient recovery outcomes.

• Coordinated with multidisciplinary teams to effectively address patient needs and improve overall care quality. Enterprise Health and Rehab

Staff LPN Enterprise, Alabama Jun 2012 - Sep 2013

• Managed care for 28 short-term and long-term patients, ensuring individualized treatment plans and high-quality medical support.

• Coordinated with interdisciplinary teams to optimize patient outcomes and improve overall healthcare delivery. Alternative Supports

Supports Coordinator/ House Manager North/West Boston Jun 2011 - Dec 2011

• Facilitated and maintained a supportive and independent living environment for adults with mental and physical disabilities.

• Coordinated resources and services to enhance the quality of life and independence for residents. Education

Ultimate Medical Academy

Associate’s Degree, Medical Billing and Coding Jun 2017 G.L.V.T.S.

Licensed Practical Nurse, Nursing 1991

St. Paul's Lutheran High School

Diploma 1982

Certifications

Making Contact: A Training for COVID-19 Contact Tracers COVID-19 Contact Tracing

Skills

Offline Team Member, Hmo/Ppo, Microsoft Teams, English

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