Michelle Santos

Obtained or Pended Authorizations for patients Durable Medical Equipment (Bent Metal, Ostomy, CPAP, Diabetic & Wound), Experience verifying a patient's health insurance benefits. I speak to clients via inbound & outbound call, Speak with Dr’s offices to request necessary medical documentation, and communicate with insurance companies to obtain prior authorizations to process patients orders.

Obtained or Pended Authorizations for patients Surgical or Medical Procedures. Experience verifying a patient's health insurance benefits. I have worked with all types of insurance plans, providers and networks as well as Medicare, Medicaid, Veterans Benefits, Tricare, Workers Compensation. Utilized the Epic system for all patients cases.

Obtained Prior Authorizations for Injectable medication known as Synagis which was to prevent Respiratory Syncytial Virus (RSV). I also updated patients case files, made outbound calls to Insurance Companies, to Patients Parents, Foster Parents as well as Social Workers to welcome them to the program, obtain & update demographic information, process any changes that needed to be updated as well.

Processed hospital order intakes for the purpose of authorizing or pre-authorizing various types of durable medical equipment for patients discharging the hospital. Verified patient’s health insurance. I have worked with all types of insurance plans, providers and networks as well as Medicare, Medicaid, Veterans Benefits, Tricare, Workers Compensation and Cares Act for Covid 19 patients.

Initially processed authorizations & pre-authorizing lab orders for blood testing of patients in order to participate in wellness programs through their health insurance. Promoted to a lead position within a year and was a subject matter expert for a team of employees. One year after that promotion I became the Quality Assurance manager until our office closed.

Completed an Associate in Business degree, focusing on foundational business principles. Studied various aspects of business operations and management.

Obtained a high school diploma with a focus on General Studies. Developed foundational knowledge across various academic subjects.