LiveCareer
LiveCareer
  • Dashboard
  • Jobs
  • Resumes
  • Cover Letters
  • Resumes
    • Resumes
    • Resume Builder
    • Resume Examples
      • Resume Examples
      • Nursing
      • Education
      • Administrative
      • Medical
      • Human Resources
      • View All
    • Resume Search
    • Resume Templates
      • Resume Templates
      • Nursing
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • View All
    • Resume Services
    • Resume Formats
    • Resume Review
    • How to Write a Resume
    • CV Examples
    • CV Formats
    • CV Templates
    • Resume Objectives
  • Cover Letters
    • Cover Letters
    • Cover Letter Builder
    • Cover Letter Examples
      • Cover Letter Examples
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • Business Operations
      • View All
    • Cover Letter Services
    • Cover Letter Templates
    • Cover Letter Formats
    • How to Write a Cover Letter
  • Jobs
    • Mobile App
    • Job Search
    • Job Apply Tool
    • Salary Calculator
    • Business Letters
    • Job Descriptions
  • Questions
  • Resources
  • About
  • Contact
  • 0Notifications
    • Notifications

      0 New
  • jane
    • Settings
    • Help & Support
    • Sign Out
  • Sign In
Member Login
  • LiveCareer
  • Resume Search
  • Prior Authorization Representative
Please provide a type of job or location to search!
SEARCH

Prior Authorization Representative Resume Example

Resume Score: 80%

Love this resume?Build Your Own Now
PRIOR AUTHORIZATION REPRESENTATIVE
Professional Summary

Reliable Prior Authorization Representative with advanced skill in conferring with insurance companies to verify insurance coverage eligibility. Well-organized and thorough with excellent customer service skills. Adept in completing diagnostic and procedure coding. Offering 20 years experience int the medical industry. Detail-oriented worker with knowledge of account management and collaborating with other departments. Talented at data entry and analysis with exceptional knowledge of micro soft office.

Skills
  • Patient Scheduling
  • Electronic refill request processing
  • Retro-Authorizations
  • Basic medical terminology
  • Insurance authorization
  • Electronic records management
  • Cover determination requests
  • Benefit Coverage
  • Authorizations
  • Supply maintenance
  • Medical Coding
  • Digital filing
  • Customer inquiries
  • Payment collection
  • Data Analysis
  • Customer service
  • Problem resolution
  • Operational improvement
  • Team management
  • Process improvement
  • MS Office
  • Project organization
  • Business operations
  • Supervision
  • Organization
  • Communications
  • Team building
Work History
Prior Authorization Representative, 06/2013 to 05/2020
Mountain Pain & Spine – Bountiful, Utah
  • Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Created and maintained spreadsheets detailing all medical procedures, including applicable denials and approvals.
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Tracked referral submission during facilitation of prior authorization issuance.
  • Maintained compliance with patient privacy and security regulations such as HIPPA compliance.
  • Processed new medication and refill requests for authorization.
  • Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
  • Collaborated with physicians to process patients lacking coverage for planned procedures.
  • Collected and processed patient liability statements prior to service.
  • Contacted insurance companies to obtain prior authorization for medical procedures and medications.
  • Resolved patient billing inquiries and other issues efficiently.
  • Maintained patient confidentiality and safeguarded all medical records to avoid information breaches.
  • Authorized surgical and spinal procedure requests in accordance with applicable plan guidelines.
  • Communicated pertinent information to client's prescribing provider to facilitate quality service.
  • Edited letters and written material for correspondence.
  • Resolved any denials from insurances, improved operations and provided exceptional client support.
  • Worked with patient's to understand insurance needs and provided excellent customer service.
  • Maintained excellent attendance record, consistently arriving to work on time.
LDS Hospital Radology Scheduler, 02/2008 to 08/2013
LDS Hospital – S.L.C, Utah
  • Completed skilled administrative work to support all office staff and operational requirements.
  • Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing.
  • Maintained current and accurate medical records for patients.
  • Facilitated organized record retrieval and access by maintaining filing system for both in-house and discharged residents.
  • Contacted hospitals to confirm patients medical histories and prevent inaccurate diagnoses and treatments.
  • Organized paperwork such as charts and reports for office and patient needs.
  • Improved timely payment of bills by developing flexible payment plans for patients.
  • Completed and filed financial documentation for accounting purposes.
  • Carried out front office duties utilizing data entry skills in framework of medical database.
  • Coordinated front office duties, including customer service, patient scheduling and billing.
  • Supported providers in outpatient medical office through coordinating all administrative operations.
  • Maintained office supplies inventory by checking stock and ordering new supplies as needed.
  • Located, checked in and pulled medical records for patient appointments and incomplete charts.
  • Coordinated patient scheduling, check-in, check-out and payments for billing.
  • Received, recorded and addressed incoming and outgoing communication via telephone and email.
  • Organized patient files and streamlined operations to improve efficiency.
  • Managed master calendar and scheduled appointments for multiple providers based on optimal patient loads and clinician availability.
  • Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
  • Successfully scheduled patient appointments and placed reminder calls to deliver exceptional customer experience.
  • Answered phone calls and messages for multiple physicians and medical facility, scheduling appointments and handling patient inquiries.
Patient Service Representative, 03/2002 to 08/2013
Intermountain Healthcare – SLC & Bountiful, Utah
  • Compiled and reviewed medical charts.
  • Balanced deposits and credit card payments each day.
  • Reviewed daily care slips for doctors.
  • Reviewed and corrected claim errors to facilitate smooth processing.
  • Took copayments and compiled daily financial records.
  • Explained plans for treatment and payment options.
  • Assisted patients in filling out check-in and payment paperwork.
  • Maintained excellent attendance record, consistently arriving to work on time.
  • Resolved problems, improved operations and provided exceptional client support.
  • Handled multiple phone calls to address customer inquiries and concerns.
  • Managed multiple physician daily schedules.
Education
High School Diploma: 06/1991
Woods Cross High - Woods Cross
High School Diploma: 09/2005
Weber State University - Ogden, UT
Build Your Own Now

DISCLAIMER

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

Companies Worked For:

  • Mountain Pain & Spine
  • LDS Hospital
  • Intermountain Healthcare

School Attended

  • Woods Cross High
  • Weber State University

Job Titles Held:

  • Prior Authorization Representative
  • LDS Hospital Radology Scheduler
  • Patient Service Representative

Degrees

  • High School Diploma : 06/1991
    High School Diploma : 09/2005

Create a job alert for [job role title] at [location].

×

Advertisement

Similar Resumes

View All
Prior-Authorization-Representative-resume-sample

Prior Authorization Representative

Medco Health/Express Scripts

Mesquite, Texas

Prior-Authorization-Representative-resume-sample

Prior Authorization Representative

Express Scripts

Dublin, Ohio

Prior-Authorization-Representative-resume-sample

Prior Authorization Representative

NCO

Saint Joseph, Missouri

About
  • About Us
  • Privacy Policy
  • Terms of Use
  • Sitemap
Help & Support
  • Work Here
  • Contact Us
  • FAQs
Languages
  • EN
  • UK
  • ES
  • FR
  • IT
  • DE
  • NL
  • PT
  • PL
Customer Service
customerservice@livecareer.com
800-652-8430 Mon- Fri 8am - 8pm CST
Sat 8am - 5pm CST, Sun 10am - 6pm CST
  • Stay in touch with us
Site jabber winner award

© 2021, Bold Limited. All rights reserved.