Precertification Coordinator Resume Example Emory Healthcare

PRECERTIFICATION COORDINATOR

Summary

Knowledge of procedure authorization and its direct impact on the practice's revenue cycle.
Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.
Basic understanding of human anatomy, specifically musculoskeletal.
Excellent computer skills including Word and Internet use.
Detail oriented with above average organizational skills.
Plans and prioritizes to meet deadlines.
Excellent customer service skills; communicates clearly and effectively.
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.

Skills

Experience

Precertification Coordinator, Emory Healthcare, July 2008-CurrentLagrange, GA

Review chart documentation to ensure patient meets medical policy guidelines.
Prioritize incoming authorization requests according to urgency.
Obtain authorization via payer website or by phone and follow up regularly on pending cases.
Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.
Respond to clinic questions regarding payer medical policy guidelines.
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
Follow up with payer to discuss authorization status.
Other duties as assigned.

Office Manager, TRT Ranch and Supply, December 2004-September 2007Lagrange, GA

Performed various administrative functions for assigned accounts at a family owned business.
Arrange for debt repayment or establish repayment schedules, based on customers' financial situations.
Three years experience in QuickBooks with general bookkeeping duties including payroll.
Created and managed electronic customer records, encompassing data entry and administrative functions related to billing and accounts receivable.
Conducted performance evaluations of office staff to monitor progress and productivity and recommend promotions, corrective or disciplinary actions.
Managed office budget to handle all needs, including inventory. Improved operation efficiencies, managing work requests, new orders, pricing and changes while coordinating logistics to verify delivery dates.

Medical Practice Manager, Woodland Rural Health Clinic, June 1996-December 2004Woodland, AL

Coordinated financial operations, including budgeting, accounting, expenses, and financial reporting.
Mentored and coached interns and newly hired team members on office procedures and the computer system.
Complied with OSHA and HIPAA regulations.
Employed active listening and interpersonal talents to effectively interact with various individuals, including physicians, patients and fellow employees.
Assisted with the development of regulatory compliance systems.
Created and maintained electronic record management (EMR) systems to store data and develop reports.
Supervised day-to-day operations of facility, complying with strict corporate policies and guidelines.
Addressed any patient or team member concerns immediately.
Checked entire office and waiting areas regularly to provide clean and organized surroundings.
Coordinated and organized patient records for maximum efficiency.
Supported the entire practice's staff, which boosted efficiency and improved the overall process flow.

Insurance Verification Coordinator, Gordon C. Ussery, M.D., September 1971-June 1996Roanoke, AL

Signed payment approvals accepted claims.
Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
Examined claims, records and procedures to grant approval of coverage.
Handled billing related activities focused on medical specialties.
Ensuredthat appropriate coding is managed to maximize efficiency.
Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Verified that patients had the proper insurance coverage prior to any procedures or appointment scheduling.
Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information.
Ensured that all patient and insurance data was updated regularly and carefully inputted into the company's computer system.
Retained strong medical terminology understanding in effort to better comprehend procedures.
Created master spreadsheet to record procedures, denials and approvals.
Learned CPT and ICD-10 codes to support office needs.
Improved customer satisfaction by finding creative solutions to problems.
Recognized by management for providing exceptional customer service.
Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.

Education and Training

General Curriculum, , Southern Union State Community College, WadleyAL

High School DiplomaWoodland High School, , Woodland, AlabamaMay 1971

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