Mercy F.
Mid-Level Prior Authorization Nurse
Open to offersNew to PlatformAbout
Mercy Fe O. is an accomplished healthcare professional based in Las Pinas, Metro Manila, with a robust background in nursing and healthcare administration. She has effectively contributed to the smooth operation of healthcare services during her tenure as a Prior Authorization Nurse at EXL Service, a US-based Aetna organization. Her role involved managing communications with healthcare providers, adeptly handling EHR systems, and securing authorization for medical procedures while ensuring strict HIPAA compliance. Previously, Mercy worked as a Customer Service Representative at Expert Global Solutions, focusing on member services for Anthem Blue Cross Blue Shield, where she excelled in eligibility and benefits verification. Her early career as a Staff Nurse at Perpetual Succour Hospital showcased her proficiency in surgical care. With a Bachelor of Science in Nursing from Saint Paul University Dumaguete and training in insurance verification and claims processing using tools like Citrix and Avaya, she is now poised for a position as a Medical Virtual Assistant.
Experience
PRIOR AUTHORIZATION NURSE
EXL SERVICE AETNA - US-BASED · 2016 — 2026Managed telephone calls, emails, and faxes to healthcare providers, performing triage and data entry into electronic health record (EHR) systems in compliance with HIPAA to obtain authorization for medical procedures and prescriptions. Conducted verification of patients' eligibility and benefits, ensuring accurate details on coverage. Interpreted clinical records data, applying appropriate clinical criteria to align requested services with insurance guidelines. Coordinated clinical resolutions with clinicians to validate authorization and medical necessity for procedures. Undertook retrospective reviews as part of the claims evaluation process.CUSTOMER SERVICE REPRESENTATIVE
EXPERT GLOBAL SOLUTIONS ANTHEM BLUE CROSS BLUE SHIELD - US-BASED · 2012 — 2016Provided assistance to members by handling inbound calls promptly and courteously. Verified eligibility and benefits by checking contract details to confirm active coverage and copayments. Addressed and resolved members' problems and complaints, ensuring proper resolution during calls. Maintained accurate documentation of client communications while adhering to HIPAA compliance.STAFF NURSE
PERPETUAL SUCCOUR HOSPITAL · 2007 — 2011Acted as an operating room nurse, collaborating with the surgical team and addressing the needs of both the sterile and unsterile teams throughout the perioperative and postoperative phases. Established a safe environment for surgical patients and assessed, diagnosed, and evaluated treatments to maintain physiological stability. Delivered ethical care that supported patients' rights and demonstrated knowledge of physiological, sociological, and spiritual responses to surgical procedures.
Skills & Expertise
Education
- Bachelor of Science in NursingSaint Paul University Dumaguete · 2002 — 2006
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