Pharmacy Prior Authorization Specialist Resume Example First Urology

PHARMACY PRIOR AUTHORIZATION SPECIALIST

Professional Summary

23 years experience in customer service with 17 years in healthcare benefits. My goal is to work for a company where I can utilize my training and be part of a team environment.

Skills

Outpatient surgery coding specialist
Patient referrals expert
Familiar with commercial and private insurance carriers
Insurance and collections procedures
Understands insurance benefits

Medical terminology expert
Billing and collection procedures expert
Records management professional
Records maintenance professional
Outpatient surgery coding specialist

Work History

Pharmacy Prior Authorization Specialist, 09/2005 to Current
First Urology – 101 Hospital blvd Jeffersonville, IN

Complete FMLA and Short term Disability forms for all patients of 32 doctors
Obtain Prior Authorizations for denied medications for 19 doctors
Check in patients, take co-pays and post them as well as balance the days money
Check out patients and schedule future appointments and testing
Professionally and courteously verify appointment times with patients.
Assist in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
Diligently file and follow up on third party claims.
Assign appropriate medical codes with a number percent accuracy rate.
Determine prior authorizations for medication and outpatient procedures.
Pre-certify medical and radiology procedures, surgeries and echocardiograms.
Maintain strict patient and physician confidentiality.
Submit electronic/paper claims documentation for timely filing.
Identify and resolve patient billing and payment issues.
Treat all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.
Schedule appointments, register patients and distribute sample pharmaceuticals as prescribed.

Billing Associate, 12/2002 to 09/2005
Norton Healthcare – Louisville, KY

Schedule appointments, register patients and distribute sample pharmaceuticals as prescribed.
Accurately complete appropriate claims paperwork, documentation and system entry.
Professionally and courteously verify appointment times with patients.
Verify patients' eligibility and claims status with insurance agencies.
Assign appropriate medical codes with a number percent accuracy rate.
Determine prior authorizations for medication and outpatient procedures.

Care Manger Assistant, 04/2000 to 11/2002
National Health Services – Louisville, KY

Professionally and courteously answere incoming calls for procedure pre-certifications.
Utilize excel spreadsheets daily
ICD9 and CPT coding

Secretary/ Bookkeeper, 03/1998 to 04/2000
Frost Arnett Co – Louisville, KY

Answer 15 line phone system, update data base, filing and computer input
10 person staff, online bookkeeping and operating various office equipment
Contact for client questions
Account receivable post and deposit

Acct Specialist, Claims Examiner, 04/1989 to 03/1992
Prudential Service Bureau – Louisville, KY

Handle and resolve customer complaints. Communicate directly with benefit representatives and healthcare carriers regarding customer service needs and grievances
ICD9 and CPT coding
Various computer reports to ensure accurate and timely reporting of participant payments and benefits status
Process enrollment forms, claim forms, preliminary information sheets and correspondence
Performe duties as medical claim examiner for 3 years
Investigate rejected claims or payment

Education

High School Diploma: Business/ accounting, 1982
Bullitt East H.S - Mt. Washington, KY

Continuing education in COBRA regulations
ICD9 and CPT coding
Medical claims payer course
Training in customer service and diversity training
Knowledge of industry related computer systems which involved creating industry forms for training data entry

Resume Overview

Companies Worked For:

First Urology
Norton Healthcare
National Health Services
Frost Arnett Co
Prudential Service Bureau

School Attended

Bullitt East H.S

Job Titles Held:

Pharmacy Prior Authorization Specialist
Billing Associate
Care Manger Assistant
Secretary/ Bookkeeper
Acct Specialist, Claims Examiner

Degrees

High School Diploma : Business/ accounting , 1982

Pharmacy Prior Authorization Specialist Resume Example

Resume Score: 70%

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