prior authorization representative resume example with 18+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
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.

  • 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 - 05/2020
Aetna Inc. Auburndale, FL,
  • 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 Radiology Scheduler, 02/2008 - 08/2013
Carle Foundation Hospital Bridgeport, IL,
  • 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 - 08/2013
Intermountain Healthcare City, STATE,
  • 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.
High School Diploma: , Expected in 06/1991
Woods Cross High - Woods Cross,
Status -
High School Diploma: , Expected in 09/2005
Weber State University - Ogden, UT
Status -

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Resume Overview

School Attended

  • Woods Cross High
  • Weber State University

Job Titles Held:

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


  • High School Diploma
  • High School Diploma

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