Central Authorization Specialist Resume Example Henry Ford Health System

CENTRAL AUTHORIZATION SPECIALIST

Professional Summary

Driven professional with 10 + years hands-on experience in fast-paced hospital environments. Open and disciplined communicator with analytical and adaptable approach. Dependable and trustworthy and ready to be challenged.

Skills

EPIC experienced
Performed insurance verification, pre-certification and pre-authorization
Medical billing code accuracy
Strong computer skills and working knowledge of Microsoft
Regulatory compliance
Strategic decision-making

Analytical thinking
Electronic Medical Record
Strong work ethic, reliable, resourceful, with enthusiastic attitude
Strong ability to work independently
ICD-10 medical terminology experience preferred
Customer Service

Work History

Henry Ford Health SystemCentral Authorization Specialist | Troy, Michigan | May 2017 - Current

Insurance verification, procure pre-authorization for outpatient ordered services
Verifying authorization requirements through payer portal and payer grid
Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes
Monitor and track patient authorizations
Communicate data with clinical staff to ensure that services are provided within parameters of authorization
Create, manage and maintain referrals for accuracy
Upload all correspondence letters pertaining to authorizations
Review medical records in Epic for retrieval for authorization submission
Pull electronic medical records and transferred information to appropriate parties
Ensured timely processing of benefits information by utilizing interactive face sheet real-time eligibility check
Identified important patient and demographic information
Gathered information to file appeals for denials and minimized inaccuracies by maintaining accurate records of approvals
Address, document, and respond to incoming and outgoing calls and correspondence

McLaren MacombPatient Account Representative | Shelby Township, MI | September 2016 - May 2017

Reviewed account information to conform patient and insurance information is accurate
Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management
Reviewed medical records to meet insurance company requirements
Utilized computer programs to create invoices, letters and other documents
Posted payments and processed refunds
Processed and managed insurance appeals
Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes
Verified final claim submissions by comparing account charges with documentation
Addressed and responded to provider inquiries regarding CPT and diagnosis codes
Added modifiers, coded narrative diagnosis and verified diagnoses
Utilized electronic charge capture systems to consolidate and streamline billing processes
Answered desk phone and handled phone calls and questions

Henry Ford HospitalBilling Specialist I | Troy, MI | January 2015 - September 2016

Proficiently handled claims follow-up and denials for hospital and professional billing
Verified final claim submissions by comparing account charges with documentation
Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management
Verified accuracy and integrity of motor vehicle and workers' compensation claims through careful research and analysis
Reviewed medical records to meet insurance company requirements
Filed and submitted insurance claims
Documented and filed patient data and medical records
Reviewed all claims for accurateness and appropriateness
Investigated denials and collaborated with internal team members and third-party representatives to identify solutions
Submitted claims to insurance companies
Flagged return claims and dealt with insufficient payments
Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules

Henry Ford Macomb HospitalUnit Secretary | Clinton Township, MI | October 2009 - January 2015

Developed training protocols for new unit secretaries
Welcomed and directed patients and visitors anticipating needs
Provided information for patient admissions and discharges to foster timely processing
Organized paperwork such as charts and reports for office and patient needs
Ordered and distributed nursing unit stock and supplies
Maintained rapport with all unit staff, including physicians, nurse and other healthcare personnel
Monitored and managed patient census for high volume, outpatient nursing unit
Organized patient files and streamlined operations to improve efficiency
Coordinated front office duties, including customer service, patient scheduling and billing

Education

Associate of Applied ScienceInterior DesignBaker College Clinton Township, MI | June 2001

Certifications

Certified Medical Billing and Coding Specialist ( CBCS)- National Health Care Association.-2015

Resume Overview

Companies Worked For:

Henry Ford Health System
McLaren Macomb
Henry Ford Hospital
Henry Ford Macomb Hospital

School Attended

Baker College

Job Titles Held:

Central Authorization Specialist
Patient Account Representative
Billing Specialist I
Unit Secretary

Degrees

Associate of Applied Science Interior Design

Central Authorization Specialist Resume Example

Resume Score: 80%

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