Jamila Moten

• Acquiring prior authorization for standard of care medical services and clinical trial-related treatments in adherence to Medicare, Medi-Cal, state, federal, and FDA guidelines
• Obtaining medical health benefits for specialized services, procedure precertification and predetermination, eligibility verification
• Facilitated communication between insurance companies and internal departments to ensure smooth operations. between insurance companies, contracting, internal, and ancillary departments.
• Managed appointment logistics with multiple provider offices to enhance patient experience. with multiple provider offices internally and externally
• Obtained and tracked authorizations, appointed patients, made referrals for consults, diagnostics, and ancillary services, coordinated hospital services, completed billing documentation, and explained provisions and requirements to patients.
• Researching and reviewing applicable CMS local and national coverage determinations and indications for billing; document that procedures meet conditions for billing consistent with CMS guidelines.
• Tracked and organized pending projects to ensure timely completion and efficient workflow. of pending projects and work, update work plan accordingly.
• Assumed responsibilities for surgery scheduling, ensuring authorizations and timing were effectively managed. for Surgery Scheduling, obtaining authorizations coordinating surgery date and time with hospital and the patient.
• Engaged in educational webinars to continuously update knowledge of payer policy changes. to keep up to date with payer policy changes.
• Used Epic to schedule appointments.

• Maintaining the surgery authorizations for a provider group consisting of ten physicians with multiple offices and surgical facilities
• Prioritizing authorization workload based on medical necessity and contracted surgical facility
• Coordinated with surgery coordinators to secure necessary authorizations before procedure dates
• Verified insurance eligibility and provided patients with coverage information and guidance
• Maintaining open lines of communication with all physicians and their clinic staff to ensure the correct insurance information is obtained
• Facilitated communication with physicians and clinic staff to ensure accurate insurance information was obtained
• Answering calls and providing payment solutions and alternatives to accommodate patient needs
• Providing secondary support to surgery center for obtaining facility authorization for outside providers.
• Providing secondary support to surgery center for payment collection
• Interviewing and training all new Surgery Authorization Liaison staff
• Executed various administrative tasks
• Work on special projects; perform other duties as assigned or requested

Handled patient questions and concerns with the highest degree of courtesy and professionalism to relieve patient anxiety and instill confidence in practice physicians and faculty

• Scheduled and confirmed patient medical consultations, diagnostic procedures and surgeries
• Processed insurance claim forms to facilitate timely reimbursement and minimize patient financial burden
• Reviewed medical records and contacted patients to ensure completion (i.e. intake documents, insurance forms, case histories)
• Reviewed medical records and contacted patients to ensure completion of intake documents and insurance forms, enhancing patient readiness for appointments
• Interviewed patients on quality of care and compiled data to identify practice strengths and areas for improvement, supporting quality enhancement initiatives
• Interviewed patients on quality of care and compiled data for practice strengths versus areas of opportunity for improvement
• Utilized strong listening and problem solving skills to develop solutions that met clients’ real and perceived needs
• Coordinated patient scheduling and appointment confirmations to enhance operational efficiency.
• Assisted patients with inquiries, ensuring accurate information delivery and improved satisfaction.
• Processed insurance verifications and prior authorizations, maintaining compliance with provider requirements.
• Led initiatives to optimize front desk workflows, improving overall patient experience during visits.
• Monitored performance metrics related to patient interactions, implementing strategies to boost engagement and retention.
• Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
• Verified insurance eligibility and coverage for patients.
• Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
• Managed patient registration process, confirming data accuracy and completeness.
• Improved patient satisfaction by providing exceptional customer service during check-in and check-out processes.
• Provided exceptional customer service to patients, answering questions and addressing concerns.
• Utilized electronic health record (EHR) systems for accurate patient data management and retrieval.
• Trained new staff on office procedures and customer service protocols to ensure consistency in operations.
• Developed streamlined processes for handling patient complaints, resulting in enhanced service recovery efforts.
• Filed and maintained patient records in accordance with HIPAA regulations.