Proven ability to support agents in meeting key performance indicators (KPIs) through effective coaching, counseling, and when necessary, disciplinary action. Trusted to review and approve high-level medical procedure requests that exceed standard agent approval limits, ensuring compliance with policy and medical necessity.
Adept at handling escalations and resolving patient or provider complaints with professionalism and empathy. Committed to contributing to the overall success of the team by delivering results, fostering collaboration, and ensuring excellent service delivery across operations.
Proficient in resolving patient concerns professionally and escalating issues when necessary. Committed to upholding patient confidentiality and ensuring full compliance with HIPAA regulations.
Knowledgeable and service-oriented Patient Care Navigator with experience supporting members and healthcare providers in the HMO setting
Proficient in reviewing and approving medical procedure requests based on member eligibility, ICD-10 diagnoses, and CPT codes. Skilled in navigating complex healthcare policies and ensuring that approvals align with plan coverage and medical necessity guidelines.
Experienced and patient-focused Medical Secretary with a strong background in providing administrative and clinical support in a customer-facing healthcare setting. Collaborates closely with a multidisciplinary team of physicians, including Pediatricians, Surgeons, Internists, OB-Gynecologists, Orthopedists, Cardiologists, and Pulmonologists, to support both clinical and administrative needs.
