insurance authorization specialist resume example with 5+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
Home: (555) 432-1000
Cell:
resumesample@example.com
:
Professional Summary
Detail oriented Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 2 years of managing documentation. Considered team player with exemplary multitasking skills and vast knowledge of medical terms. Offering 5 years of customer service experience, and 2.5 years of remote work experience in the medical system with obtaining medical prior authorizations, appeals, cost estimates, invoices, patient advocacy, and patient support.
Skills
Obtaining Authorizations
Compassionate Communication
Group Management
Knowledge of Treatments
Work Organizing and Prioritizing
Policy and Procedure Explanations
Demographics Information
Call Transfers
Problem Resolution
Data Verification
Reminder Calls
Digital Filing
Creative Thinking
Accurate Recordkeeping
Customer Satisfaction
Privacy Regulations
Confidential Records Management
Payment Collection
Personnel Files
Patient Data Privacy
Regulatory Compliance Adherence
Status Updates
Health Insurance Plan Knowledge
Diagnostic Codes
Clinical Messaging
Commercial Insurance
Insurance Information Oversight
Healthcare Terminology
Insurance Authorizations
Premium Collection
Authorization Verification
Electronic Health Record Applications
Benefits Verifications
Surgical Procedures
Invoice Statements
CPT Coding
Work History
Insurance Authorization Specialist, 06/2023 to Current Skagit Regional Health – , , Remote
Responded to inquiries from healthcare providers regarding prior authorization requests.
Input all patient data regarding claims and prior authorizations into system accurately.
Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
Analyzed medical records and other documents to determine approval of requests for authorization.
Verified eligibility and compliance with authorization requirements for service providers.
Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
Tracked referral submission during facilitation of prior authorization issuance.
Patient Experience Manager, 12/2022 to 04/2023 Bojangles' Restaurants, Inc. – , , Bristol, TN
Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
Communicated with patients, ensuring that medical information was kept private.
Direct day-to-day administrative and operational functions for 300 in-bed facility, providing guidance and leadership to over 70 employees across departments.
Motivated and supervised fifteen Patient Dining Associates in delivering quality patient care.
Increased patient satisfaction scores by 7% within three months.
Insurance Authorization Specialist, 02/2020 to 09/2022 Sonic Drive-In – , , Remote, TN
Obtained Medical Prior Authorizations on a daily basis including but not limited to; Neurosurgery, General Surgery, OB/GYN, Optometry, Orthopedic, and Injectables.
Submitted Reconsiderations/Appeals for denied cases, followed up with providers and payors until outcome was reached.
Made contact with insurance carriers to discuss policies and individual patient benefits.
Submitted verbal and written notification to members and providers.
Provided outreach for additional information for appeals and grievances.
Assured timely verification of insurance benefits prior to patient procedures or appointments.
Maintained confidentiality of patient finances, records and health statuses.
Checked documentation for accuracy and validity on updated systems.
Verified client information by analyzing existing evidence on file.
Calculated adjustments, premiums, and refunds.
Collected premiums and issued accurate receipts.
Notified insurance agents and accounting departments of policy cancellations and changes.
Processed and recorded new policies and claims.
Prepared insurance claim forms or related documents and reviewed for completeness.
Coordinated with contracting department to resolve payer issues.
Documented all communication with applicants and inputted information into system using Epic.
Shift Manager, 02/2018 to 02/2020 Company Name – , , Bristol, VA
Trained and mentored new employees to maximize team performance.
Supervised employees and oversaw quality compliance with company standards for food and services.
Kept employees operating productively and working on task to meet business and customer needs.
Exercised composure under pressure and in escalated customer service scenarios.
Excelled in every store position and regularly backed up front-line staff.
Worked closely with team members to schedule breaks and shifts to meet state regulations.
Consistently exhibited calm demeanor during periods of high volume or unusual events to keep store operating smoothly and set positive example for shift team.
Managed schedules, accepted time off requests and found coverage for short shifts.
Evaluated performance, adjusted strategies and maintained agile, sustainable operations.
Advised new employees on company procedures and policies to facilitate daily tasks and responsibilities.
Cooperated with coworkers to improve customer experience and manage storefront.
Tracked receipts, employee hours and inventory movements.
Assisted management team in developing and creating welcoming atmosphere for crew members to voice complaints.
Devised new promotional approaches to boost customer numbers and market penetration while enhancing engagement and driving growth.
Crew Leader, 08/2016 to 10/2017 Company Name – , , Blountville, TN
Discussed daily work requirements with crew and assigned skills-based tasks to enable completion of work.
Trained employees in time management and proper ways to complete job duties.
Monitored team members to verify work quality and address concerns.
Pitched in to help with various job tasks, fill in for sick employees and complete projects.
Instructed crew members in safe work practices and methods to reduce work-related injuries.
Supervised end-of-day cleanup activities to remove debris and unnecessary supplies from customer premises.
Pitched in to help on short-staffed job site and to meet looming project deadlines.
Complied with Occupational Safety and Health Administration (OSHA) regulations to maintain safe work environment.
Transported daily work materials to worksite and staged supplies in work area to facilitate timely completion of day's goals.
Communicated effectively with upper management, team members and customers to keep everyone informed.
Monitored overall team and individual employee performance and compiled data into project reports for supervisor.
Worked in team environment to maintain high levels of productivity.
Monitored materials inventory and requested items for restocking for each job.
Organized materials, tools and equipment to supply team members.
Education
Certified Medical Coder: Medical Coding, Expected in 05/2022 to Virginia Highlands Community College - Abingdon, VA GPA:
Certified Phlebotomy Technician: Phlebotomy, Expected in 09/2019 to Northeast State Community College - Blountville, TN, GPA:
High School Diploma: , Expected in 05/2018 to Family Christian Academy - Knoxville, TN, GPA:
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