LiveCareer-Resume

prior authorization representative resume example with 20+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Administrative and Business operations with Medical office and Radiology Scheduling. Authorized to work in the US for any employer. Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Skills
  • Patient Insurance Authorizations
  • Client Service
  • Co-Payment Collection
  • ICD Code Fluency
  • Medical Insurance
  • Understanding of Medical Terms
  • Insurance Information Oversight
  • Traditional Filing
  • Document Preparation
  • Account Management
  • Typing 40 WPM
  • Customer Service
  • Training & Development
  • Good Work Ethic
  • Supervision & Leadership
  • Reliable & Trustworthy
  • Planning & Organizing
  • Conflict Resolution
  • Flexible Schedule
  • Critical Thinking
  • Team Management
  • Problem Resolution
  • People Skills
  • Relationship Building
  • Computer Skills
  • Microsoft Office
  • Organizational Skills
  • Data Management
  • Friendly, Positive Attitude
  • Active Listening
Experience
Prior Authorization Representative, 06/2022 - 11/2022
Bioplus Specialty Pharmacy Longwood (Ahhi), FL,
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Notified ordering providers of denied authorizations.
  • Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
  • Maintained high level of professionalism when speaking to doctors and insurance companies.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Used [Software] to input claim, prior authorization and other important medical data into system.
Appointment Scheduler, Center Associate, 09/2019 - 06/2022
Trinity Health Corporation Dexter, MI,
  • Administrative business office including answering phones, setting medical appointments, front desk setting appointments for general, referrals in Radiology
  • Money
  • Offered exceptional services and support to team members and guests, maximizing productivity and customer satisfaction.
  • Scheduled and confirmed appointments.
  • Called no shows and cancellations to reschedule.
  • Provided exceptional customer service through effective telephone communication and follow-ups.
  • Provided information regarding services and policies.
  • Created and maintained accurate and complete records of all customer interactions in job-related software.
  • Distributed to team members to support open communication and quality customer service.
  • Checked office supplies stock and placed orders to maintain levels.
  • Pleasantly welcomed visitors, answered phone calls and maintained front reception desk.
  • Organized files, developed spreadsheets, faxed reports and scanned documents, maintaining front desk and reception area in neat and organized fashion.
  • Sorted and distributed incoming faxes, letters and emails for office distribution.
  • Handled incoming calls and directed callers to appropriate department or employee.
  • Maintained front desk to provide positive first impression.
Money Center Associate, 12/2018 - 03/2019
Unitypoint Health Moline, IL,
  • Cash payroll checks, bill payments, money gram, money orders, cashiering, customer service
  • Processed customer transactions and applied appropriate fees.
  • Explained money center rules and regulations to customers.
  • Stocked and maintained money center area.
  • Answered customer questions about money services.
  • Prepared and checked cashier register tills.
  • Reconciled daily cash variance reports, tracking overages and shortages through compilation of summary reports and comparing against past variances to isolate and address possible causes.
  • Answered customer phone calls, personally addressing questions within scope of competence and forwarding calls to other departments or managers as appropriate.
  • Greeted customers promptly and responded to questions.
  • Answered phone calls to assist customers with questions and orders.
  • Processed customer payments quickly and returned exact change and receipts.
  • Counted and balanced cashier drawers.
  • Maintained work area and kept cash drawer organized.
  • Kept check-out areas clean, organized and well-stocked to maintain attractive store.
  • Processed efficient and accurate cash, check, debit and credit card payments using Point-of-Sale system.
Dept Manager, 10/2017 - 12/2018
Walmart City, STATE,
  • Handled shift overstock, restocking and inventory control.
  • Worked closely with sales associates to complete tasks.
  • Followed safety protocols and company processes and procedures.
  • Kept department on-target to meet sales and profit objectives by minimizing waste and pursuing revenue generation opportunities.
  • Executed targeted merchandising and promotional plans to meet department sales goals.
  • Supported shrinkage and safety awareness, reviewed sales and inventory data, identified trends and prepared reports for management.
  • Modeled supportive leadership qualities, motivating staff to achieve department goals and promote staff participation and team building.
  • Enforced safety rules and other policies to protect employees and minimize company liability.
  • Exercised discretion and judgment in managing fast-paced environment adapting to change with sense of urgency.
  • Prepared weekly schedules to verify proper floor coverage within fiscal guidelines.
  • Balanced workloads to meet targets without overtaxing employees.
  • Cultivated talented team of departmental employees through outstanding mentoring, coaching and teaching skills.
  • Oversaw storewide merchandising benchmarks to maintain operational excellence.
  • Grew department's team and technical capabilities with hiring and training of talented individuals.
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations.
  • Resolved customer inquiries and complaints requiring management-level escalation.
  • Recruited and trained new employees to meet job requirements.
  • Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
  • Reviewed completed work to verify consistency, quality and conformance.
  • Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
  • Delegated work to staff, setting priorities and goals.
  • Completed thorough opening, closing and shift change functions to maintain operational standards each day.
  • Created and managed budgets for travel, training and teambuilding activities.
  • Organized team activities to build camaraderie and foster pleasant workplace culture.
  • Proposed or approved modifications to project plans.
  • Analyzed business performance data and forecasted business results for upper management.
  • Produced thorough, accurate and timely reports of project activities.
  • Evaluated individual and team business performance and identified opportunities for improvement.
  • Interviewed prospective employees and provided input to HR on hiring decisions.
  • Mediated conflicts between employees and facilitated effective resolutions to disputes.
  • Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.
  • Assigned work and monitored performance of project personnel.
Customer Service, 05/2014 - 10/2017
Cap Team 1, Wal-Mart City, STATE,
  • Oversee other associates,maintaining in stock, scanning outs
  • Restocking, price changes, making schedules and adjusting hours to coincide with generated and forecasted hours and answering 5 line phone system.Using computers and general clerical as needed
  • Restock of product from backroom to sales floor, filling outs and customer service
  • Accomplishments
  • Making sure that the proper items are pulled from bins to restock.and bin items that are overstock in proper bins with correct counts
  • Skills Used
  • Use Gemini handheld scanner, pulling hand carts, pulling pallets, oversee other associates,maintaining in stock, scanning outs
  • Restocking, price changes, making schedules and adjusting hours to coincide with generated and forecasted hours and answering 5 line phone system
  • Accomplishments
  • I was able to manage the Dept while multitasking and providing great customer.service.
Manager Domestics/ Cosmetics, 07/1991 - 05/2014
Dep, Wal-Mart City, STATE,
  • Highlighted new products by creating displays to enhance brand awareness and amplify engagement.
  • Assisted customers in selecting correct products to fit skincare regimen or makeup routine.
  • Recommended additional products and services based upon information provided or items already selected.
  • Arranged counter offerings and promotional products to create eye-catching displays.
  • Managed recruiting, hiring and performance monitoring of sales team.
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations.
  • Completed thorough opening, closing and shift change functions to maintain operational standards each day.
  • Resolved customer inquiries and complaints requiring management-level escalation.
  • Delegated work to staff, setting priorities and goals.
  • Recruited and trained new employees to meet job requirements.
  • Reviewed completed work to verify consistency, quality and conformance.
  • Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
  • Assigned work and monitored performance of project personnel.
  • Produced thorough, accurate and timely reports of project activities.
  • Interviewed prospective employees and provided input to HR on hiring decisions.
  • Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.
  • Evaluated individual and team business performance and identified opportunities for improvement.
  • Mediated conflicts between employees and facilitated effective resolutions to disputes.
  • Organized team activities to build camaraderie and foster pleasant workplace culture.
  • Proposed or approved modifications to project plans.
  • Planned and delivered training sessions to improve employee effectiveness and address areas of weakness.
  • Analyzed business performance data and forecasted business results for upper management.
Education and Training
AA: Health, Expected in 05/2020
-
Crafton Hills College - Yucaipa, CA
GPA:
Status -
High School Diploma: General, Expected in 01/1984
-
San Bernardino. High School - San Bernardino, CA
GPA:
Status -

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Resume Overview

School Attended

  • Crafton Hills College
  • San Bernardino. High School

Job Titles Held:

  • Prior Authorization Representative
  • Appointment Scheduler, Center Associate
  • Money Center Associate
  • Dept Manager
  • Customer Service
  • Manager Domestics/ Cosmetics

Degrees

  • AA
  • High School Diploma

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