Clarina Reang
Agartala
Summary
Dynamic Prior Authorization Specialist with extensive experience at Officium Healthcare (Client - Mission Surgical Clinic), adept at optimizing patient care through effective communication and problem-solving. Proven track record in managing authorizations and insurance coverage, while ensuring compliance with HIPAA standards. Strong leadership skills foster team collaboration and enhance operational efficiency in fast-paced environments. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Officium Healthcare
06.2023 - Current
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Verified eligibility and compliance with authorization requirements for service providers.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures via telephone, fax or designated IPA portals.
- 30-60 submissions are done per day.
- Tracked referral submission during facilitation of prior authorization issuance.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Developed and maintained productive working relationships with healthcare providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Communicated pertinent information to client's prescribing provider to facilitate quality service.
- Processed new medication and refill requests for authorization on cover my meds or via fax.
- Created and maintained spreadsheets detailing medical procedures and insurance denials and approvals.
- Maintained patient confidentiality and safeguarded medical records to avoid information breaches.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Performed various administrative tasks by filing, copying and faxing documents.
- Promoted high morale and staff retention through dynamic communication, prompt problem resolution, proactive supervisory practices and facilitation of positive work environment.
- Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.
- Delegated tasks to staff members, monitored completion of all duties and provided support to enhance performance.
- Identified opportunities to improve clinical practices, devised strategies and implemented plans to increase patient care standards and enhance operational procedures.
- Oversaw overall operation of nursing services and patient care.
- Monitored all phone calls and scheduled appointments.
- Handled job duties for staff members which were unavailable or out of office.
- Communicated with patients, asked appropriate questions, and employed active listening to determine best care.
Lead Clinical Coordinator
Officium Healthcare
08.2021 - 06.2023
- Supervised and managed daily activities of clinical team consisting of 5 clinical and 2 support staff.
- Coordinated, monitored, assigned, and documented patient and clinical care activities.
- Devised and implemented clinical protocols (SOP) to ensure high-quality patient care.
- Built strong relationships with patients and families for optimized care satisfaction.
- Mentored new clinical staff members for proper onboarding and orientation processes.
- Upheld quality assurance process to maintain patient safety and satisfaction in the clinic via remote virtual assistance.
- Scheduled office new patient encounters and follow ups, managed pre-certifications and verified insurance coverage.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Assisted in the screening process of hiring.
- Continuous coordination with different healthcare providers, home health agencies, hospice care, Durable medical equipment facilities, Sleep therapy clinics and skilled nursing facilities to promote effective coordination of care.
- Handling of all sensitive medical information and documents of clients and responsible for effectively sharing these protected health data or information across systems.
- Referring patient's for labs, radiology and specialty cares and obtaining authorizations as per the member's plans guidelines.
Assistant Clinical Coordinator
Doctor Alliance
04.2021 - 08.2021
- Supervised and managed daily activities of clinical team consisting of 15 members.
- Maintained compliance with protocols covering patient care and clinical trial operations.
- Reviewed referral information and kept track of intakes from various referral sources.
- Resolved problems, improved operations and provided exceptional service.
- Coordinated, monitored, assigned, and documented patient and clinical care activities.
- Mentored new clinical staff members for proper onboarding and orientation processes.
- Minimized manual system errors with streamlined data entry process.
- Managed time efficiently in order to complete all tasks within deadlines.
- Acted as a team leader in group projects, delegating tasks and providing feedback.
- Passionate about learning and committed to continual improvement.
- Learned and adapted quickly to new technology and software applications.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Documented care plan needed for patients with chronic and terminal illness.
- Evaluating the SOAP (Subjective Objective Assessment plan) to asses and determine the need for special care specifically for patients with limited activities or those facing challenges in performance of activities of daily Living(ADL) .
- Documenting the care plan oversight.
Education
MBA - Healthcare Managaement
Manipal Academy Of Higher Education
Manipal, India09-2025
Bachelor of Science - Nursing
St Ignatius Institute of Health Sciences
HONNAVAR02-2021
High School Diploma -
Holy Cross School
Agartala06-2016
Skills
- Administrative task such as Data entry, Insurance benefit coverage, VOB, authorizations, Retro authorizations, CPT coding, ICD coding, Scheduling and coordination
- Medical terminology knowledge, pharmacology and precertification requirements, Patient referrals
- Understanding of HIPAA standards
- Medical coding for outpatient surgeries
- Strong verbal communication
- Proficiency in project management and collaboration tools
- Process optimization
- Prescription coordination, Physician order verification
- Knowledgeable in [Electronic health record systems such as Epic, ECW, ATHENA, PRACTICE FUSION, ADVANCE MD etc] and Records maintenance
- Problem-solving skills, Decision-making, Follow-up skills, Strong interpersonal skills
- Time management
- Data collection
- Escalation management
- EMR updating
- Team leadership
- Quality improvement strategies
Certification
- Patient Safety and Quality Improvement: Developing a Systems View (Patient Safety I) - Johns Hopkins University
- Strategic Leadership and Management Capstone - University of Illinois Urbana-Champaign
- Foundations of Public Health Practice: The Public Health Approach -Imperial College London
- The Social and Technical Context of Health Informatics -John Hopkins University
- Financial Management for Product Leaders - University of Maryland, College Park
- Understanding Research Methods - University of London
- Project Initiation: Starting a Successful Project - Google
Timeline
Prior Authorization Specialist
Officium Healthcare
06.2023 - Current
Lead Clinical Coordinator
Officium Healthcare
08.2021 - 06.2023
Assistant Clinical Coordinator
Doctor Alliance
04.2021 - 08.2021
MBA - Healthcare Managaement
Manipal Academy Of Higher Education
Bachelor of Science - Nursing
St Ignatius Institute of Health Sciences
High School Diploma -
Holy Cross School