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Central Authorization Specialist Resume Example

Resume Score: 80%

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CENTRAL AUTHORIZATION SPECIALIST
Professional Summary

Offering 10+ years of experience and willingness Enthusiastic [Job Title] eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of [Task] and [Task] and training in [Skill]. Motivated to learn, grow and excel in [Industry]. Trained in [Software] use and administration with knowledge of [Area of expertise]. Dedicated to excellent customer service and best-in-class collaboration.

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
  • Proficiency in Microsoft Office Products
  • Resource information
Work History
Baycare Health System, IncCentral Authorization Specialist | Brooksville , FL | 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
  • Communicate data with clinical staff to ensure that services are provided within parameters of authorization.
  • Create, manage and maintain referrals for accuracy.
  • Review medical records in Epic for retrieval for authorization submission.
  • 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.
Canyon View Medical GroupPatient Account Representative | Santaquin , UT | September 2016 - May 2017
  • 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.
  • 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.
  • Worked with outside entities to resolve issues with billing, claims and payments.
  • Reviewed account information to conform patient and insurance information is accurate.
Amerisourcebergen Corporation - CorporateBilling Specialist I | Richmond , VA | January 2015 - September 2016


  • Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
  • Executed billing tasks and recorded information in company databases.
  • Verified insurance and demographic information ensuring claims were sent to player accurately.
  • Analyze accounts to discover discrepancies and resolve variances.
  • Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments.
  • Verified proper ICD-10 coding and procedure codes on claims.
  • Researched and followed up on denied insurance claims.
Trinity Health CorporationUnit Secretary | Detroit , MI | October 2009 - Current
  • Supported office staff and operational requirements with administrative tasks.
  • Organized paperwork such as charts and reports for office and patient needs.
  • Developed training protocols for new unit secretaries.
  • Enhanced office productivity by handling high volume of callers per day.
  • Maintained rapport with all unit staff, including physicians, nurse and other healthcare personnel.
  • Monitored and managed patient census for high volume, outpatient nursing unit.


News America MarketingMerchandiser | October 2018 - December 2020
  • Completed seasonal windows, dressed mannequins and arranged displays according to in-store planograms.
  • Promoted seasonal products and trends to move stock and prepare for incoming inventory.
  • Communicate key finding in daily visits/weekly through store reports to account manager.




Education
Associate of Applied ScienceInterior DesignBaker College City, State | June 2001
Certifications

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

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Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

School Attended

  • Baker College

Job Titles Held:

  • Central Authorization Specialist
  • Patient Account Representative
  • Billing Specialist I
  • Unit Secretary
  • Merchandiser

Degrees

  • Associate of Applied Science Interior Design

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