Healthcare Case Manager & Medical Specialist I am a dedicated healthcare professional with over 3 years of experience in medical operations and BPO settings. I leverage a Bachelor of Science in Radiologic Technology to provide clinical insight into patient care, diagnostic procedures, and medical documentation. My expertise lies in managing complex HMO authorizations, facilitating insurance appeals, and ensuring seamless coordination between healthcare providers and payers.
Core Competencies:
Clinical Knowledge: Strong foundation in medical terminology and diagnostic imaging, including X-ray, CT Scan, and Ultrasound procedures.
Case Management: Expert in subacute HMO authorizations for skilled nursing facilities, specifically for Medicare, Medicaid, and Workers' Comp.
Medical Billing & Claims: Experienced in medical bill reviews, resolving claim-related inquiries, and managing Aetna medical/dental benefits.
Documentation & Coordination: Proven ability to secure essential medical records, submit clinical updates, and manage the patient authorization appeal process.
Patient Experience: Skilled in front-office management, appointment scheduling, and resolving inquiries regarding coverage and eligibility.
Technical Skills: Proficient in Microsoft Office Suite and specialized healthcare CRM platforms.l summary
