Nanayaw Mensah
Laurel
Summary
Diligent clinical administrative coordinator with background in coordinating clinical activities and improving patient care processes. Recognized for implementing efficient workflows that enhance operational productivity and streamline communication across departments. Demonstrated expertise in managing patient schedules and maintaining detailed records, ensuring high standards of care and compliance.
Overview
13
13
years of professional experience
Work History
Clinical Coordinator
United Health Group
03.2019 - 01.2025
- Coordinate all issues related to referral processing of all IV therapies
- Determining insurance coverages, out of pocket and co-pays on behalf of patients, facilities and provider offices
- Facilitate prior authorization process through various medication and medical platforms
- Includes but not limited to Cover MyMeds, Availity, MBM Now and most major health insurance PA platforms
- Identify alternative funding research and conducts administrative tasks in support of the patient enrollment to the program
Patient Access Specialists
Alpha Consulting Corp (AstraZeneca Access360 Program)
05.2018 - 12.2018
- Manage day to day activities of health care provider support requests and deliverables across multiple communication channels i.e
- Phone, Fax, Chat, eMail, etc
- Perform in-depth research into patient’s insurance, prior authorization and appeal requests on behalf of the provider
- Serve as a resource for Health Care Providers and patients and use regional reimbursement, distribution and payer policy expertise to provide solutions for complex patient access situations, working closely with the Patient Access Management team to appropriately escalate/resolve issues
- Educate offices on programs and referral process to ensure timely case processing
Senior Reimbursement Support Analyst
Lash Group
01.2012 - 11.2018
- Handle day-to-day activity within reimbursement services, conduct research to ensure health insurance benefits or other financial assistance are available to patients for the products related to the program activities
- Provide assistance with complex reimbursement, insurance benefit investigation, prior authorization, and appeal requests
- Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives)
- Review and problem-solve returned, disputed, or rejected claims
- Resolve coding questions and complicated claim rejections/denials and identify reasons for rejections and institute corrective action to reduce denial incidence
- Work on patients’ behalf to identify and assess reimbursement coverage option for those with insurance and or coordinate and/or investigate financial options for those without insurance
- Serve as a resource to patients as well as other healthcare professionals regarding insurance coverage and medical billing for specific procedures
- Gather required documentation to determine Patient assistance eligibility and provide patients and healthcare providers with eligibility determination notification
Education
Northern Virginia Community College
Skills
- Advanced knowledge on CPT, HCPC and ICD-10 Coding
- Advanced knowledge of Medical and PBM prior authorization processes
- Proficient in most Medical and Pharmacy prior authorization platforms
- Experience with HIPAA policy, patient access data and analytics
Timeline
Clinical Coordinator
United Health Group
03.2019 - 01.2025
Patient Access Specialists
Alpha Consulting Corp (AstraZeneca Access360 Program)
05.2018 - 12.2018
Senior Reimbursement Support Analyst
Lash Group
01.2012 - 11.2018
Northern Virginia Community College
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