Jafanya B.

Experience

1. Intake Specialist

   EXL

   Nov 2025 — Present · IN

   Dedicated healthcare administrative professional with expertise in coordinating comprehensive medical services, member intake, and provider relations. Proven track record in supporting clinical quality effectiveness through meticulous documentation, regulatory compliance, and seamless communication across multidisciplinary teams. Skilled in navigating complex healthcare systems of AETNA(MedCompass, QNXT) to ensure members receive timely access to benefits and services.Key ResponsibilitiesClinical Intake & Coordination: Manage the end-to-end coordination of medical services, including intake, screening, and referrals. Process incoming requests from members and providers via telephone, fax, and EDI.Operational Consistency: Deliver consolidated telephonic support for all Eastern markets, ensuring operational consistency and departmental efficiency.Authorization & Benefits Management:* Perform non-medical research, including eligibility, Coordination of Benefits (COB), and benefit plan verification.Approve services not requiring medical review in strict accordance with specific benefit plans.Support the precertification process in compliance with NCQA standards, state/federal regulations, and company policies.Data & Systems Management: Utilize specialized healthcare systems of AETNA (MedCompass, QNXT, ProFAX, and ProPAT) to build, research, and maintain accurate member records.Stakeholder Communication:* Serve as a primary liaison between internal staff (Nurses, Medical Directors, Case Managers) and external parties (Providers, Plan Sponsors, Third-Party Payers).Conduct outbound calls to providers to facilitate clinical information exchange and authorization approvals.Compliance & Quality Assurance:* Maintain comprehensive documentation meeting risk management and accreditation requirements.Uphold strict member confidentiality and adhere to HIPAA and corporate data protection policies.

Education

• Savitribai Phule Pune University

  Bachelor of Business Administration - BBA