Glenn Mark Najorra

Experience

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  UnitedHealth Group

  Feb 2014 - Jun 2016

  Health Advisor

  - Work with hospitals, clinics, facilities, and the clinical team to manage request for services from members and/or providers.- Provide appropriate triage and care coordination notification cases for non-clinical assessment/intervention.- Review Claims and Medical Records regarding diagnosis and procedure codes.- Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification, and census roles.- Handle resolution/inquiries from members that may include:*Benefit and Eligibility information*Billing and Payment issues*Customer material requests*Physician assignments*Authorization for treatment*Explanation of Benefits (EOB) Show less

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  Omega Healthcare Management Services Private Limited

  Jun 2016 - May 2017

  Medical Coder

  - Perform medical coding reviews on abstracted medical records from primary care, inpatient and specialist settings.- Review medical records for diagnosis accuracy and completeness, based on US healthcare industry risk adjustment coding guidelines.- Using client’s data entry application, perform data entry of ICD-10-CM diagnosis codes substantiate through the medical record review.- Identify opportunities to educate providers on enhancing clinical documentation and providing accurate and thorough assessments of clinical care.- Maintain quality, productivity and compliance standards as specified by the client.- Retrospective review of records and coded data for audit. Show less

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  National Debt Relief, LLC

  Feb 2017 - Apr 2020

  Quality Assurance Specialist

  - Completes calibration surveys by specified due dates/times and has a daily, weekly and monthly survey quota to reach.- Prepares departmental reports.- Manages the QA SharePoint repository to improve department specific information sharing.

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  Dietitians At Home

  Apr 2020 - Feb 2021

  Scheduling Specialist

  - Obtaining and recording patient medical histories, vitals, test results and other information for medical records while maintaining strict confidentiality.- Answering phone calls, creating appointments, directing the calls as required and handling all queries.- Maintaining a filing system for all patient documents and reports submitted.- Answering emails and other electronic messages as required.- Ensuring compliance with all health care regulations, including HIPAA.

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  Bright Heart Health

  Feb 2021 - Oct 2021

  Prescription Coordinator

  Areas of experience: • Mental Health, Chronic Pain/Opioid Use Disorder, Substance Use Disorder• Managed Care Organizations (Health Insurance)• Electronic Health Record/Electronic Medical Record- Processing prescriptions electronically and ensuring all information is complete and accurate.- Collaborate with various health care professionals to provide holistic and high-quality care to every patient.- Processing Prior Authorization for controlled substances adhering to security measures and quality standards.- Resolve issues when they arise (e.g. rejected insurance claims)- Address concerns and issues of the patient with regard to the prescription request. Show less

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  The MediCentral

  Nov 2021 - Jan 2023

  Data Entry Specialist

  - Performs data entry tasks involving patient demographics and billing information into the company's Electronic Health Record system.- Uploads registration forms from Google Docs to Electronic Medical Record.- Calendar management — creating a schedule that includes appointments with patients as well as other commitments.- Confirms accuracy of registration and insurance date.- Manages the team and ensures that the team is productive and working swiftly to accommodate patients in real time.- Provides insight and solves problems regarding Data Entry procedures. Show less

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  All Seniors Care Living Centres

  Jan 2023 - now

  Personal Support Worker

  • Participate in all aspects of resident care, while remaining constantly vigilant with regard to ensuring the safety of our residents.• Contribute to conserving a reassuring environment that meets the physical, emotional, spiritual, and psycho-social needs of our residents.• Encourage and assist residents’ participation in recreational and rehabilitation programs.• Assist with the preparation and serving of meals, nourishments, and dietary supplements.• Establish and preserve a good rapport with residents’ families and significant others, offering support as appropriate.• Look after the neatness of residents’ rooms, e.g., drawers, closets, bathrooms, etc; and common areas such as utility rooms, serveries, and bathrooms.• Maintain complete and accurate documentation as regards residents’ care. Show less