Dynamic Non-Clinical Coordinator with Prior Authorization expertise

THE COLONY, TX *****

214-***-**** *******@*****.*** WWW: Bold Profile

PROFESSIONAL SUMMARY

Outgoing Non-Clinical Coordinator, with experience overseeing multiple tasks and managing prior authorizations successfully. Hardworking professional committed to providing outstanding customer service and assistance. Supporting the nurses and supervisors with demonstrated expertise in professional exemplifies multidisciplinary managerial skill in process, procedure and policy improvement initiatives. Accomplished in workflow optimization techniques implementation which increase productivity, reduce labor and maintain business integrity and quality of service.

EXPERIENCE

UNITED HEALTHCARE

Clinical Administrative Coordinator - Prior Authorization Richardson, TX October 2019 - October 2025

•Non-Clinical Coordinator, processing Prior Authorizations for Medicaid states New Jersey, New York, Louisiana and Texas.

•Take ownership of the cases when they are assigned to Work Queue each day.

•Managed approximately 25 - 40 Prior Authorization cases each day; based on if overtime was given.

•Scrubbing the cases to make sure they have all the information needed to process the case.

•Cases are worked based on the state's Compliance rules.

•Once a decision is made, depending on the state, letters and phone calls are made to the Provider that submitted the case.

UNITED HEALTHCARE

Resolution Specialist - SME RICHARDSON, TX March 2015 - January 2019

•Worked for United Healthcare's PHS-HMO Benefits plan, guiding and educating the advocates.

•Learned the value of a Call Center environment and how it supports the Providers.

•Managed approximately 30-40 incoming calls, emails and faxes per day from customers.

•Expedite the closure of issues and inquiries presented by employees and external customers.

•Assisted the Providers by training them how to get their Explanation Of Benefits.

•Responsible for answering carrier and vendor inquiries regarding interface files, claims and billing.

ACCOR BUSINESS & LEISURE CORPORATE OFFICE

Benefits Analyst Carrollton, TX August 2014 - March 2015

Accor Business & Leisure Corporate Office moved the Corporate office to Florida. I didn't want to move to Florida. I was given a large Severance package

ACCOR BUSINESS & LEISURE CORPORATE OFFICE

Benefits Analyst Carrollton, TX September 2012 - August 2014

•Developed and implemented effective communication strategies for promoting benefit programs to employees, resulting in increased participation rates.

•Collaborated with HR team to design and administer annual benefits open enrollment events, leading to a smooth process for all employees.

•Managed approximately 30-40 incoming calls, emails and faxes per day from customers.' • Checked employees' benefits enrollment for accuracy and inputted all data into PeopleSoft.

•Implemented open enrollment system to streamline benefits processes for employees.

ACCOR BUSINESS & LEISURE CORPORATE OFFICE

Benefits Specialist Carrollton, TX April 2006 - September 2012

•Assisted in resolving complex benefits issues, leading to increased employee satisfaction and retention rates.

•Explained benefits to plan participants in easy to understand terms in order to educate each on available options.

•Built relationships with vendors to foster quality service delivery.

•Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.

•Checked employees' benefits enrollment for accuracy and inputted all data into PeopleSoft.

•Performed benefits audits to identify discrepancies and opportunities for improvement in plan design or administration.

•Maintained compliance with federal regulations regarding FMLA, ADA, and other relevant laws governing employee benefits.

•Managed COBRA compliance, ensuring timely notifications and accurate administration for former employees.

EDUCATION

HIGH SCHOOL DIPLOMA

North Miami Senior High School

Miami, FL June 1968

SKILLS

•Office management • ICD-10 coding

•Healthcare system resources • Case review

•Provider relations • Policy implementation

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