Mwikali N

Case Manager/Claims Assessor-Carepay International

Mar 2025 - Present • 1 yr 2 mos

Coordinate patient care and insurance processes, ensuring timely approvals and smooth access to healthcare services. Manage pre-authorizations, referrals, and admissions while collaborating with healthcare providers, insurers, and patients. Perform insurance eligibility verification via phone and online portals, resolving discrepancies efficiently. Review, validate, and process medical claims for accuracy, coverage, and regulatory compliance. Maintain up-to-date case records and visit documentation in EMR/EHR systems, ensuring HIPAA compliance. Monitor patient cases from admission to discharge, providing continuity of care and same-day or next-day documentation. Assist patients with billing and insurance inquiries, delivering clear guidance and empathetic support. Generate reports and dashboards to track claim status, patient care trends, and opportunities for process improvement. Key Skills: Case Management | Medical Documentation | EMR/EHR Management | Insurance Verification | Pre-Authorizations | Billing Support | Patient Coordination | HIPAA Compliance | Clinical & Administrative Support

Clinician In Charge-Machakos Doctors Plaza

Jun 2022 - Feb 2025 • 2 yrs 8 mos

Led daily clinical and administrative operations, supporting 20+ patient interactions per day through patient care delivery, treatment coordination, scheduling, and referrals. Verified insurance eligibility, managed prior authorizations, and performed ICD-10 and CPT coding, maintaining 99% accuracy in clinical and billing documentation. Managed EMR/EHR documentation, patient scheduling, and follow-up coordination to ensure continuity of care, accurate records, and timely updates across healthcare workflows.