Livecareer-Resume
Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary
  • Motivated Prior Authorization Specialist with experience successfully managing and monitoring eligibility information for members and groups. Highly skilled at facilitating program approval or denial through qualifications assessment, fact checking and record keeping. Confident and committed to promoting positive customer outcomes through dynamic communication and exemplary engagement skills. My extensive experience as a Registered Nedical Assistant provides me with additional clinical experience and knowledge needed to perform both the clerical and clinical demands of a high volume medical facility.
Skills
  • CPR certified through American Heart Association
  • CPC Certified AAPC
  • RMA certified AMA
  • PROFESSIONAL SUMMARY
  • SKILLS
  • EDUCATION
  • WORK HISTORY
  • CERTIFICATIONS
  • Interpersonal
  • Communication skills
  • CPR certified
  • Documentation
  • Filing
  • Insurance
  • Listening
  • Managing
  • Access
  • Insurance claims
  • Medical office administration
  • EMR / EHR
  • Completing Insurance Forms
  • Patient Scheduling
  • Authorizations
  • Multitasking abilities
  • Verbal and written communication
  • Benefit Coverage
  • Physician order verification
  • Retro-Authorizations
  • Claim research
  • Medical Coding
  • Pharmacology
  • Effective communication skills
  • Prescription Coordination
  • Understanding of insurance details
  • Medical terminology
  • Customer inquiries
Work History
Prior Authorization Specialist, 07/2018 - Current
Gila Regional Medical Center Silver City, NM,
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Ensured that every individual received a high level of service by employing dynamic communication, interpersonal and active listening skills.
  • Reviewed insurance coverage for patients to determine which party was liable for payment.
  • Facilitated organized record retrieval and access by maintaining filing system for both in-house and discharged residents.
  • Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing.
  • Researched denied claims and contacted insurance companies to resolve these issues.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Maintained files and controlled records to show correspondence activities.
  • Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.
  • Completed form letters in response to requests or problems identified by correspondence.
  • Communicated with executives about consistent customer issues.
  • Edited letters and written material for correspondence.
Registered Medical Assistant, 09/2014 - 08/2017
Atrium Health Nc, NC,
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed.
  • Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
  • Directed patients to exam rooms, fielded questions and prepared for physician examinations.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Enhanced patient outcomes by providing knowledgeable education on procedures, medications and other physician instructions.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Taught patients about medications, procedures and care plan instructions.
  • Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs.
  • Compiled necessary documents for surgical billing packages.
  • Prepared initial patient charts for admission.
  • Obtained pre- and post-treatment vital signs and weight.
  • Obtained client medical history, including medication information, symptoms and allergies.
Registered Medical Assistant, 09/2006 - 08/2012
Atrium Health Columbus, NC,
  • Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed.
  • Completed clinical procedures and gathered patient data for interpretation by physician.
  • Obtained client medical history, including medication information, symptoms and allergies.
  • Compiled necessary documents for surgical billing packages.
  • Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus.
  • Directed patients to exam rooms, fielded questions and prepared for physician examinations.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Taught patients about medications, procedures and care plan instructions.
  • Gathered forms, copied insurance cards and Action to collect patient information for billing and insurance filing.
Education
Bachelor Nursing : Nursing , Expected in 09/2024
-
County College of Morris - Randolph Township, NJ
GPA:
: Medical Assisting, Expected in 08/2006
-
The Chubb Institute-Westbury - Westbury, NY
GPA:
Certifications

CPR certified through American Heart Association

CPC Certified AAPC

RMA certified AMA

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School Attended

  • County College of Morris
  • The Chubb Institute-Westbury

Job Titles Held:

  • Prior Authorization Specialist
  • Registered Medical Assistant
  • Registered Medical Assistant

Degrees

  • Bachelor Nursing

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