authorization specialist resume example with 7 years of experience

(555) 432-1000,
, , 100 Montgomery St. 10th Floor

Dependable Prior Authorization Specialist with a career spent handling various administrative responsibilities in fast-paced settings. Bilingual individual dedicated to finding solutions to issues and obtaining prior authorization information for patients. Ready to tackle new challenges.

  • Strongly self motivated, reliable
  • Proven ability to have strong organizational skills with capacity to handle numerous projects simultaneously.
  • Proficient in Athena Net and Profitware software
  • HIPPA and OSHA compliance
  • Medical Terminology
  • Effective Communication Skills
  • Patient Scheduling
  • Records Maintenance
  • Billing Procedures
  • Recordkeeping and Data Input
  • ICD 10, CPT and procedure codes knowledge
Education and Training
Lincoln Technical Institute - Hartford Lowell Ma, Expected in 06/2012 Certificate : Medical Assisting - GPA :
Lehigh Valley Hospital & Health - Authorization Specialist
Lehighton, PA, 10/2021 - Current
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
  • Coordinated resolutions for issues and appealed denied authorizations.
  • Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
  • Notified ordering providers of denied authorizations.
  • Used Multi softwares to input claim, prior authorization and other important medical data into system.
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
  • Proofread documents carefully to check accuracy and completeness of all paperwork.
Computer Aid - General Clerk
Center Valley, PA, 12/2020 - 10/2021
  • Resolved client issues by correcting immediate problems and communicating with staff.
  • Created and updated client records by entering general data, services provided and invoice information.
  • Assessed customer satisfaction with services through follow-up communication.
  • Safeguarded patient privacy with strict adherence to HIPAA protocols.
  • Answered questions and responded to inquiries to deliver high level of service to patients.
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
  • Maintained accurate records and documented client data in company databases.
  • Built partnerships with related organizations to develop support and gain greater attention for important issues.
  • Scheduled patients according to availability, urgency and insurance authorization guidelines.
  • Reviewed demographic, clinical and insurance information before sending to referred specialists.
  • Reviewed referral details and expectations with providers and patients and requested new referrals when necessary.
  • Answered questions and resolved concerns raised by both patients and specialists.
  • Compiled, recorded, or coded data from referrals or surveys using computer or specified form.
  • Verified documents and associated records to catch and resolve discrepancies.
  • Prepared reports to provide responses to specific problems.
Yale-New Haven Health - Administrative Assistant - Client Care Specialist
Fairfield, CT, 04/2017 - 11/2020
  • Fyzical Dizziness and Fall Prevention Center (Ancillary service for New England ENT, Assisted in opening of new PT clinic including Administration set up, furniture organization and development of day to day operations
  • Management of front office and supervision of PT aides, including participating in training of staff members using software and day to day operations
  • Participate in the interview process for hiring Physical Therapists, PTAs, and administrative assistants
  • Interpreting during PT Evaluations and treatments for providers while assisting with deliverance of care
  • Assist in health fairs and community marketing initiatives
  • Independent run reports regarding PT office statistics, specifically referral rate, cancellation rate, patient census, etc
  • Manage PT and PTA schedules by communicating with Patients and verifying insurance benefits
  • Perform Computerized Dynamic Posturography testing on patients to assess motor and sensory balance malfunction
  • Carry out PT treatment dictated by PT for patients of all ages with Vestibular and Neurological diagnosis
  • Oversee the sales of our on site store (including sales of CBD balm)
  • Explained eligibility details and affordability options to patients with kindness and respect.
  • Participated in new hire training and development tasks.
New England ENT - Medical Secretary
, , 05/2016 - 11/2020
  • Interpreting for ENT specialist (MD and PA's) during patient appointments to assist in the deliverance of high quality patient care
  • Answering phone calls from patients, offices, and insurance companies using a multi line phone system
  • Manage patient concerns, questions, and appointments by communication center for busy
  • ENT and Facial plastic surgery
  • Worked in the front office delivering excellent customer service, while utilizing Athena Net system for checking in/out, scheduling, requesting orders, etc.
  • Managed physician calendar, scheduling patient appointments and procedures.
  • Conducted patient intake interviews to collect medical information and insurance details.
  • Applied knowledge of medical terminology and insurance processes to support office administration productivity.
  • Documented and responded to incoming correspondences to address questions.

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Resume Overview

School Attended

  • Lincoln Technical Institute - Hartford

Job Titles Held:

  • Authorization Specialist
  • General Clerk
  • Administrative Assistant - Client Care Specialist
  • Medical Secretary


  • Certificate

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