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Medical Information Specialist Resume Samples
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Candidate Info
years in workforce
years at this job
Microbiology
Administrative Science
Pharmacy
Medical Information Specialist
Delivered accurate and balanced information in response to complex inquiries related to on- and off- label therapeutic uses and safety guidelines. Compiled research and data from relevant medical literature creating detailed summaries for clinical replies.
- Consolidated training materials and incorporated concise and relevant information reducing product training time by 50%.
- Earned Top 1% in quality monitoring scores for customer service and case documentation.
- Identified, investigated and accurately documented adverse events and product quality complaints maintaining compliance with federal guidelines and regulations and adhering to client specific policies.
- Provided subject matter expertise in Respiratory and Oncology products.
- Reviewed and evaluated team reports and responses ensuring accuracy, quality, and compliance.
- Established and executed a process to handle complex inquiries from healthcare providers utilizing medical literature searches prior to response generation reducing unprocessed queries.
Candidate Info
years in workforce
years at this job
Medical Practice-clinical Management
Bachelor of Arts
Medical Information Specialist
Assess and investigate cases for medical/surgical authorization and authorize select services that do not require clinical review or judgment based on product knowledge
- Assist providers and specialist with referral changes for approved, pending and retrospective authorizations
- Data collection through inbound calls regarding referral intakes, questions and concerns, complete statistical data on cases for analysis of pre-service, retrospective or concurrent services.
- Verify eligibility for members, provider networks as well as follow guidelines in regards to SharePoint, CareAdvance and Facets system
- Collect and record appropriate data in order to issue authorization and route request for services that require medical review to appropriate nurse case manager
- Assist nurse team members with data research and requesting documentation as necessary particularly regarding benefit/plan limitations and historical authorizations, educate and direct providers on medical management policy, procedures, plan benefits and co-pays for all products such as Medicare Advantage, and Commercial
Candidate Info
years in workforce
years at this job
Medical Insurance Billing And Coding
Business Management
Medical Information Specialist
- Provide thorough analysis and investigation of authorization request for specialized medical/surgical/outpatient procedures in an expeditious and accurate manner
- Provide information and assistance pertaining to the Medical Management program to providers, hospitals, Provider Care Groups(PCG), and members.
- Identify relevant issues and route to appropriate department for action and resolution
- Perform departmental functions such as: data preparation/presentation, interaction with internal and external sources to resolve inquiries.
- Assist with on-the-job training of new employees as requested
- Educate and direct providers on medical management policy, procedures, plan benefits and copayments for all products.
- Promote and engage in positive and constructive daily team interactions
Candidate Info
years in workforce
years at this job
Medical Assisting / Hemodialysis
Medical Information Specialist/ Utilization Management
Provide through analysis and investigation of authorization request
- Assess and investigate requests for medical service authorization and authorize select services that do not require clinical judgment. [company name]of Michigan
- Collect and record appropriate data in order to issue authorization and route request for services that require medical review to appropriate team member(s).
- Facilitate communication with providers regarding status on authorization and referrals.
Medical Information Specialist Resume Success Stories
