SEARCH

Prior Authorization Specialist Resume Example

Resume Score: 80%

Love this resume?Build Your Own Now
TB
PRIOR AUTHORIZATION SPECIALIST
Summary

Dependable Professional with a career spent handling various administrative responsibilities in fast-paced settings. Bilingual individual dedicated to finding solutions to issues. Ready to tackle new challenges in an office-based environment. Analytically proficient in information gathering, report preparation and data compilation capabilities. In-depth knowledge of insurance coverage forms, procedures and policies. Accommodating and logical individual skillful in creating customized requests for each client. Trustworthy and always offering a keen understanding of the latest softwares and or requirements for professional settings from HR to the employee base. Determined to achieve, now my family has grown it is my time to get back into the workforce, with boasting extensive claim researching and effective collaboration skills with other members of the office staff.

Skills
  • Issue research
  • Insurance information oversight
  • Understanding of medical terms
  • Knowledgeable in Microsoft
  • Practitioner order verification
  • Precertification requirements
  • Document preparation
  • Spreadsheet management
Experience
01/2014 - 12/2014Prior Authorization SpecialistComprehensive Pain Specialists | Gallatin, TN
  • Notified ordering providers of denied authorizations.
  • Coordinated resolutions for issues and appealed denied authorizations.
  • Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
  • Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
  • Created master spreadsheet to record procedures, denials and approvals.
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Collaborated with internal departments to provide account status updates.
  • Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Updated spreadsheets and other document filing systems.
  • Gathered data to formulate appropriate replies for information requests.
Lead HostessBB kings / Itta Beana | Nashville, TN
  • Enhanced guests' experiences by fulfilling special requests during visits.
  • Stayed abreast of server availability and table turnover to make quick decisions about seating locations.
  • Answered front of house phone to inform customers of wait times, take reservations and record to-go orders.
  • Set up and decorated menu marketing boards with current meal and drink specials.
  • Accommodated guests with children, and or, VIP considered clientele and special needs to promote comfortable dining experience.
  • Completed closing duties by emptying trash, safeguarding alcohol and polishing silverware.
  • Checked dining and serving areas every 30 minute interval to verify proper cleanliness and readiness for guests.
  • Monitored dining area to assess server capacity and estimate wait times.
  • Helped restaurant staff set up small and large events to coordinate smooth execution.
Call Center RepresentativeAfni/ Verizon Wireless | Nashville, TN
  • Documented customer inquiries and feedback, including service delivery suggestions in company database.
  • Boosted productivity by maintaining strong call control and quickly working through scripts to address diverse problems.
  • Educated clients on how to navigate company systems and work within established frameworks to obtain desired services.
  • Resolved average of 500 inquiries per week to consistently meet performance benchmarks, including speed, accuracy and volume.
  • Maintained high-volume workload within fast-paced environment by assisting 140 clients per shift , DESIRED, and consistently meeting performance benchmarks.
  • Managed customer expectations by clarifying needs, identifying options and recommending products and services.
  • Evaluated customer account information to assess current issues and determine potential solutions.
  • Achieved high sales percentage with consultative, value-focused customer service approach.
Assistant General ManagerCash Express | Portland, TN
  • Coordinated monthly budgets, managed profit and loss and consistently met desired margin targets.
  • Increased annual profit by streamlining processes and improving staff knowledge of optimal procedures.
  • Efficiently met business targets to provide streamlined operations performance.
  • Tracked comment card data, logging information to identify marketing trends, needs for improvement and guest satisfaction.
  • Assessed customer needs and requirements to effectively provide product pricing.
  • Promoted membership benefits and [Type] programs to prospective clients to generate sales leads.
  • Analyzed sales presentations to cultivate projects that communicated product quality and market comparison.
  • Identified customer needs and delivered relevant product solutions and promotions.
  • Handled all customer accounts, called overdue clients, was sure to dictate all phone conversations and also was a notary of the public, a warrant officer and civilian officer.
Education and Training
05/2008Advanced Medical Assistingqq: Medical Assisting
Remington College | Nashville TN
12/2004High School Diploma
East Robertson High School | Cross Plains
References

MS. Rhonda Talley P: 615-500-1452

Hendersonville, Tn 37075

Yrs known: 14 Professional and personal ref.

worked at Hendersonville Family Healthcare together in chart room.

Ms. Kimberly Henderson P: 629-213-8048

Cross Plains, TN 37049

Yrs known: 22

Went to high school, college and worked side by side many yrs.

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:

  • Comprehensive Pain Specialists
  • BB kings / Itta Beana
  • Afni/ Verizon Wireless
  • Cash Express

School Attended

  • Remington College
  • East Robertson High School

Job Titles Held:

  • Prior Authorization Specialist
  • Lead Hostess
  • Call Center Representative
  • Assistant General Manager

Degrees

  • 05/2008 Advanced Medical Assistingqq : Medical Assisting
    12/2004 High School Diploma

Similar Resumes

View All
Prior-Authorization-Specialist-resume-sample

Prior Authorization Specialist

Cigna

Louisville, Kentucky