prior authorization representative resume example with 12+ years of experience

Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,
Professional Summary

Dedicated Medical Receptionist works productively with diverse personalities and experienced in busy clinical settings. Knowledgeable in schedule, records and front desk management. Offers successful career history comprising more then 10 years.

  • Benefit Coverage
  • Electronic records management
  • Patient Scheduling
  • Basic medical terminology
  • Insurance authorization
  • Prescription Coordination
  • Electronic refill request processing
  • Authorizations
  • Pharmacology
  • EPIC
  • Understanding of insurance details
  • Effective communication skills
Work History
09/2019 to Current Prior Authorization Representative Aetna Inc. | Beaver, WV,
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Created and maintained spreadsheets detailing medical procedures and insurance denials and approvals.
  • Researched denied claims and contacted insurance companies to resolve these issues.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Reached out to insurance carriers to obtain prior authorization for medications.
  • Communicated effectively between patients and doctors within the office.
  • processed all medication refill requests from vis fax, telephone and doctor's request.
09/2016 to 09/2019 Front Office Manager Inn At Perry Cabin | Saint Michael's, MD,
  • Coached employees through day-to-day work and complex problems.
  • Communicated corporate objectives across divisions through regular correspondence and scheduled status updates.
  • Interpreted management directives to define and document administrative staff processes.
  • Assisted our practice manager with interviewing potential employees by asking appropriate questions and providing feedback after interviews.
  • Resolved issues through active listening and open-ended questioning, escalating major problems to
  • Established and updated work schedules to account for changing staff levels and expected workloads.
  • Optimized organizational systems for payment collections, AP/AR, deposits and recordkeeping.
  • Maintained files and records by implementing effective filing systems that boosted efficiency and organization.
  • Kept accounts in balance and ran daily reports to verify totals.
  • Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
  • Planned coverage needs and organized services to support incoming special events.
  • Monitored office supplies by checking inventory and placing orders.
06/2012 to 06/2016 Medical Office Assistant Unitypoint Health | Bloomington, IL,
  • Adhered to strict HIPAA guidelines to protect patient privacy.
  • Coordinated patient scheduling, check-in, check-out and payments for billing.
  • Entered procedure codes and diagnosis codes into medical billing software.
  • Contacted patients regarding unpaid and underpaid accounts to resolve issues.
  • Improved timely payment of bills by developing flexible payment plans for patients.
  • Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
  • Completed administrative patient intakes with case histories, insurance information and mandated forms.
  • Managed office bookkeeping with insurance billing and patient payments.
09/2008 to 12/2012 Pharmacy Technician Wegmans Food Markets | Hunt Valley, MD,
  • Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
  • Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
  • Collected co-payments or full payments from customers.
  • Stocked, labeled and inventoried medication to keep accurate records.
  • Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
  • Counted, measured and compounded medications following standard procedures.
  • Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
  • Communicated with prescribers to verify medication dosages, refill authorizations and patient information.
  • Prepared intravenous solutions, admixtures, respiratory drugs and other solutions using aseptic techniques.
  • Counted and labeled prescriptions with correct item and quantity.
  • Entered and processed patients' prescriptions into internal system.
  • Processed incoming drug orders by checking deliveries against paperwork and updating computer system.
  • Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems and locating items.
  • Reviewed and verified customer information and insurance provider information.
  • Maintained proper drug storage procedures, registries, and records for controlled drugs.
Expected in 07/2009 High School Diploma | Seneca High School, Tabernacle, GPA:

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Resume Overview

School Attended

  • Seneca High School

Job Titles Held:

  • Prior Authorization Representative
  • Front Office Manager
  • Medical Office Assistant
  • Pharmacy Technician


  • High School Diploma

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