Experience

Affinity Health Plan

• United States
• Insurance
• 300 - 400 Employee

• Senior Credentialing Specialist

  • Jun 2014 - Present

  • Completing potential member applications received from Marketing representatives assigned • Responsible for processing all aspects of Medicaid, Child Health Plus and HARP enrollment into core systems • Process enrollments, changes and terminations from rosters, email correspondence and electronic data sources • Process error reporting and system reconciliation files • Ability to navigate and utilize multiple systems for processing • First person designated & assigned to learn, train, implement • Performs data input in a highly accurate and timely manner on all customer contacts • Identify and maintain and update the team's daily assignments and production • Organizing each Enrollment & Retention Specialist's daily assignments are completed to maximize efficiency and attain daily production • Manage the Enrollment teams monthly Pending and Completed Inventory folders • Answered a high volume of incoming member and provider calls resolving issues/complaints/claims Show less



Pelham Physical Medicine

• Bronx, NY

• Receptionist/Pre-Certification Specialist

  • Jan 2013 - Jun 2014

  • Obtaining prior authorizations for all procedural orders • Review chart documentation to ensure patient meets medical policy • Respond to clinic questions regarding payer medical policy guidelines • Contact patients to discuss authorization status • Obtaining prior authorizations for all procedural orders • Review chart documentation to ensure patient meets medical policy • Respond to clinic questions regarding payer medical policy guidelines • Contact patients to discuss authorization status



Gramercy Cardiac Diagnostic

• New York, NY

• Pre-Certification Specialist

  • Dec 2010 - Jan 2013

  • Prioritize incoming authorization requests according to • Obtain authorization via payer website or by phone and follow up regularly on pending cases • Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations • Initiate appeals for denied authorizations • Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order • Prioritize incoming authorization requests according to • Obtain authorization via payer website or by phone and follow up regularly on pending cases • Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations • Initiate appeals for denied authorizations • Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order